Surgical Approach to the VascularPedicle of the Gracilis Muscle Flap
Yasunori Hattori, MD, PhD, Kazuteru Doi, MD, PhD,Yukio Abe, MD, PhD, Keisuke Ikeda, MD, Vikas Dhawan, MD, PhD,
Aneasyandsafeapproachtothevascularpedicleofthegracilismuscleﬂapisdescribed.Withthis technique the vascular pedicle can be harvested with maximum length and the largestpossible caliber for functioning free muscle transfer. (J Hand Surg 2002;27A:534–536. Copy-right © 2002 by the American Society for Surgery of the Hand.)
Gracilis muscle, functioning free muscle transfer.
The gracilis muscle is widely used as a donormuscle for functioning free muscle transfer (FFMT)because of its single motor nerve supply, anatomicconsistency of the vascular pedicle, and large amountof excursion. We have used more than 100 gracilismuscles for FFMT mainly in brachial plexus recon-struction.
Compared with the use of the gracilismuscle as a pedicled island transfer, it is necessary toharvest a longer vascular pedicle in FFMT. We havereported our endoscopic harvesting technique of thegracilis muscle for FFMT.
In this article we describein detail our vascular dissection technique for an easyand safe approach to the vascular pedicle.
The patient is placed in supine position with thethigh abducted and the knee ﬂexed. A 10
5–cmskin ﬂap to facilitate easy closure and postoperativemonitoring of the circulation is designed proximal todistal in an oblique direction over the gracilis muscle(Fig. 1). After the skin is incised along the skin ﬂapanteriorly, the deep fascia is incised over the adduc-tor longus muscle and posteriorly over the adductormagnus muscle. The main vascular pedicle and mo-tor nerve of the gracilis are identiﬁed underneath theadductor longus muscle at the junction of the upperquarter and lower three quarters of the gracilis mus-cle (Fig. 2), but at this time the neurovascular pedicleis not dissected. The gracilis muscle distal to the skinﬂap is harvested endoscopically.
After the distalpart is harvested (Fig. 3), the neurovascular pedicle isdissected. For exposure of the neurovascular pediclethe adductor longus muscle is retracted anteriorly
From the Department of Orthopedic Surgery, Ogori Daiichi GeneralHospital, Yamaguchi, Japan.Received for publication October 10, 2001; accepted in revised formFebruary 1, 2002.No beneﬁts in any form have been received or will be received froma commercial party related directly or indirectly to the subject of thisarticle.Reprint requests: Yasunori Hattori, MD, PhD, Department of Ortho-pedic Surgery, Ogori Daiichi General Hospital, Shimogo, 862-3, Ogori,Yoshikigun, Yamaguchi, Japan 754-0002.Copyright © 2002 by the American Society for Surgery of the Hand0363-5023/02/27A03-0021$35.00/0doi:10.1053/jhsu.2002.32962
The design of the skin ﬂap for harvesting thegracilis muscle ﬂap for FFMT.
The Journal of Hand Surgery