Download PDF
J Reconstr Microsurg 2012; 28(05): 349-358
DOI: 10.1055/s-0032-1313767
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Harvest of an Entire Gracilis Muscle and Tendon for Use in Functional Muscle Transfer: A Novel Technique

Jennifer L. Giuffre
1   Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
,
Allen T. Bishop
2   Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Rochester, Minnesota
,
Alexander Y. Shin
2   Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

10 November 2011

17 January 2012

Publication Date:
15 May 2012 (online)

    Permissions and Reprints

Abstract

The use of the free functioning, innervated gracilis muscle has evolved to become an invaluable tool in the restoration of elbow flexion and prehension in patients undergoing reconstruction following brachial plexus injuries. Although there are many different methods of the gracilis muscle harvest, most if not all harvest methods begin proximally. The purpose of this article is to describe a novel distal harvest technique of the gracilis myocutaneous flap for brachial plexus patients requiring restoration of elbow or finger flexion. A harvest method commencing with a distal dissection either at the distal insertion of the gracilis at the pes anserine or at the distal medial thigh at the myotendinous junction will be described. The advantage of this novel method is to ensure that the entire gracilis muscle and its tendon are harvested to maximize the length of tendon that can be secured by a Pulvertaft weave into the biceps tendon or the finger flexors for elbow flexion and finger flexion respectively.

Keywords

harvest - gracilis muscle - tendon - muscle transfer - flap
 

  • References

  • 1 Pickrell KL, Broadbent TR, Masters FW, Metzger JT. Construction of a rectal sphincter and restoration of anal continence by transplanting the gracilis muscle; a report of four cases in children. Ann Surg 1952; 135: 853-862
    CrossrefPubMedGoogle Scholar
  • 2 Orticochea M. A new method of total reconstruction of the penis. Br J Plast Surg 1972; 25: 347-366
    CrossrefPubMedGoogle Scholar
  • 3 Pers M, Medgyesi S. Pedicle muscle flaps and their applications in the surgery of repair. Br J Plast Surg 1973; 26: 313-321
    PubMedGoogle Scholar
  • 4 Bartholdson L, Hultén L. Repair of persistent perineal sinuses by means of a pedicle flap of musculus gracilis. Case report. Scand J Plast Reconstr Surg 1975; 9: 74-76
    CrossrefPubMedGoogle Scholar
  • 5 Yousif NJ, Matloub HS, Kolachalam R, Grunert BK, Sanger JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1992; 29: 482-490
    CrossrefPubMedGoogle Scholar
  • 6 Furnas HJ. Re: The transverse gracilis musculocutaneous flap. Ann Plast Surg 1993; 30: 480
    PubMedGoogle Scholar
  • 7 Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 2004; 114: 69-73
    CrossrefPubMedGoogle Scholar
  • 8 Manktelow RT, McKee NH. Free muscle transplantation to provide active finger flexion. J Hand Surg Am 1978; 3: 416-426
    CrossrefPubMedGoogle Scholar
  • 9 Harii K, Ohmori K, Sekiguchi J. The free musculocutaneous flap. Plast Reconstr Surg 1976; 57: 294-303
    CrossrefPubMedGoogle Scholar
  • 10 Ikuta Y, Yoshioka K, Tsuge K. Free muscle graft as applied to brachial plexus injury-case report and experimental study. Ann Acad Med Singapore 1979; 8: 454-458
    PubMedGoogle Scholar
  • 11 Doi K, Muramatsu K, Hattori Y , et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg Am 2000; 82: 652-666
    CrossrefPubMedGoogle Scholar
  • 12 Mathes SJ, Nahai F. Clinical Applications for Muscle and Musculocutaneous Flaps. St. Louis, MO: CV Mosby Co.; 1982
    Google Scholar
  • 13 McCraw JB, Dibbell DG. Experimental definition of independent myocutaneous vascular territories. Plast Reconstr Surg 1977; 60: 212-220
    CrossrefPubMedGoogle Scholar
  • 14 Adams JE, Kircher MF, Spinner RJ, Torchia ME, Bishop AT, Shin AY. Complications and outcomes of functional free gracilis transfer in brachial plexus palsy. Acta Orthop Belg 2009; 75: 8-13
    PubMedGoogle Scholar
  • 15 Bishop AT. Functioning free-muscle transfer for brachial plexus injury. Hand Clin 2005; 21: 91-102
    CrossrefPubMedGoogle Scholar
  • 16 Shin AY, Spinner RJ, Steinmann SP, Bishop AT. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg 2005; 13: 382-396
    CrossrefPubMedGoogle Scholar
  • 17 Lin CH, Wei FC, Lin YT. Conventional versus endoscopic free gracilis muscle harvest. Plast Reconstr Surg 2000; 105: 89-93
    CrossrefPubMedGoogle Scholar
  • 18 Momeni A, Bannasch H. The semi-open approach to the gracilis muscle flap: aesthetic refinements in gracilis muscle harvest. J Reconstr Microsurg 2009; 25: 63-67
    Article in Thieme ConnectPubMedGoogle Scholar