What is the gracilis muscle?

Flap surgery is an operation by which a piece tissue (flap) is lifted from a healthy site in the body and moved to a site of defect while still attached to a blood supply.
Flap surgery is an operation by which a piece tissue (flap) is lifted from a healthy site in the body and moved to a site of defect while still attached to a blood supply.

The gracilis muscle is one of the muscles in the groin. It starts at the external point of the pubic bone (ischiopubic ramus) and extends down to the upper-middle shaft of the shinbone (tibia).

What is a flap surgery?

Flap surgery is an operation by which a piece tissue (flap) is lifted from a healthy site in the body and moved to a site of defect while still attached to a blood supply.

Types of flaps:

  • Cutaneous flaps contain the full thickness of skin and connective tissue. They are ideal for small defects.
  • Fascio-cutaneous flaps contain the full thickness of skin, connective tissue, subcutaneous tissue, deep fascia and more blood supply with ability to fill a larger defect.
  • Musculocutaneous or myocutaneous flaps add the muscle layer to a fascio-cutaneous flap. They provide bulk to fill deeper defects and restore function.
  • Muscle flaps only use muscle to fill defects and restore function. Skin can be placed over it, if needed.
  • Bone flaps are used to replace bone for bony defects.

What is gracilis tissue transfer?

The gracilis is a commonly used muscle to create a flap for free tissue transfer or flap surgery for reconstruction of small- to medium-sized soft tissue defects in the arms, legs, head and neck. It is a muscular flap, which means only muscle is used. Muscle flaps are commonly used to eradicate infection, fill defects following trauma or surgery and restore function.

Advantages of muscular flap:

  • Muscle flaps provide a soft tissue with a rich blood supply (well-vascularized) that is relatively resistant to infection, helps wounds heal, and offers a vascularized surface to supply blood for potential future skin grafts.

Advantages of using gracilis muscle:

  • Expendable muscle whose absence rarely causes lower extremity weakness
  • Ability to transfer only a part of the muscle
  • Good contractile force
  • Reliable in location
  • Rich blood supply (high vascularity)

Disadvantages of gracilis muscle:

  • Excessive bulk
  • Skin tethering (adhesions that pull the skin inward)
  • Donor site scar, which may require treatment
  • Secondary refining procedures are often necessary

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What are the uses of gracilis tissue transfer surgery?

  • Head and neck reconstruction 
  • Reconstruction following surgical removal of tumours
  • Reconstruction following major injury/accident
  • Long-standing or inborn facial paralysis
  • Restoring spontaneous emotional facial expressions
  • Restore the aesthetics and function of the perineum (like sphincter function)
  • Coverage for moderate-sized soft tissue defects in the arms and legs
  • Functional rehabilitation of the arms and legs
  • Treatment of chronic infection in the bone (osteomyelitis) leading to exposed  bone
  • Defects around ankle and upper part of the foot

What happens during the gracilis flap procedure?

Preparation

  • A history is obtained with focus on whether any prior trauma or surgery related to the upper thigh has occurred in the past.
  • When there has been past trauma to the area of the thigh, adequate blood supply can be determined with Doppler ultrasonography or angiography.

Procedure

  • The surgery is performed with general anesthesia.
  • The donor site is prepared by shaving, disinfecting and draping the area.
  • An incision roughly 10-cm long is made on the thigh.

What are the complications of surgery?

The complication rate is low. Possible complications are

  • Local wound problems:
  • Issues related to scarring:
    • Pruritus
    • Discoloration
    • Cosmetic problems related to width
    • Sensitivity
  • Tingling
  • Pain
  • Hypoesthesia (diminished sensation of touch in the surgical area)
  • Temporary weakness lasting an average of 6 months
  • Persistent weakness that may interfere with running, walking or sports
  • Poor reaction to anesthesia
     

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Medically Reviewed on 5/27/2020
References
Medscape Medical Reference
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