The Turbo Gracilis Myocutaneous Flap

ABSTRACT

While the gracilis muscle flap continues to be used for coverage of selected defects and in specialized applications such as facial reanimation, the lack of reliability of the distal skin component of the gracilis musculocutaneous flap has limited its usefulness. Reliable distal skin and muscle viability are particularly important when the gracilis musculocutaneous free flap is used in forearm flexorplasty. A method for “turbo-charging” this flap, to improve distal reliability, is described. The anatomy of 24 human lower extremities was studied, with respect to the arterial supply to the distal gracilis muscle and distal medial thigh skin. A consistent septal branch, originating from the superficial femoral artery proximal to the adductor canal, supplying the distal gracilis muscle as well as the overlying skin, was identified in all extremities. “Turbo-charging” via this vessel increases the reliability of both the distal skin island and distal muscle of the gracilis myocutaneous flap and enhances its versatility, when used as either a pedicle or free flap.