Skip to main content
SpringerLink
Log in

Anatomic basis for use of a gracilis muscle flap

Bases anatomiques de l'utilisation d'un lambeau du muscle gracile

  • Anatomic Bases Of Medical, Radiological And Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Summary

The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. This established the following points : 1) The arterial supply is abundant, consisting of several pedicles reaching the muscle on its deep aspect. The main neurovascular pedicle arises from the deep vessels of the thigh, via either the a. of the adductors (73%), the medial circumflex a. (19.2%) or as a double supply from both arteries (7.7%); 2) The cutaneous vascularisation over the gracilis m., derived from the solitary main pedicle, is inconstant. In 20 injections, it was satisfactory in 11 cases, poor in 5 and absent in 4; 3) The distal tendon of the gracilis m. is closely related to the posterior branch of the saphenous n. to the leg, which it crosses in an elongated X; 4) A simple method of calculation based on the distance between the upper border of the pubis and the medial femoral epicondyle allows quite precise determination of the point of entry of the main pedicle into the gracilis m. 5) Complete dissection of the main pedicle adds to the available length of the muscle flap.

Résumé

Cette étude a pour objet de préciser certains aspects anatomiques du muscle gracile en vue de l'utilisation de lambeaux musculaires ou musculo-cutanés. Elle repose sur la dissection de 84 muscles graciles chez 42 sujets ainsi que l'injection sélective du pédicule principal de 20 muscles graciles. Elle a permis de préciser les points suivants : 1) L'irrigation artérielle est riche, faite de plusieurs pédicules abordant le muscle par sa face profonde. Le pédicule principal vasculo-nerveux est issu des vaisseaux profonds de la cuisse soit par l'artère des adducteurs (73 %), soit par l'artère circonflexe médiale (19,2 %), soit par un double apport de ces deux artères (7,7 %); 2) La vascularisation cutanée en regard du muscle gracile à partir du seul pédicule principal est inconstante. Sur 20 injections elle est satisfaisante 11 fois, pauvre 5 fois et absente 4 fois; 3) Le tendon distal du muscle gracile est étroitement en rapport avec la branche postérieure jambière du nerf saphène qu'il croise en X allongé; 4) Une méthode de calcul simple à partir de la distance entre le bord supérieur du pubis et l'épicondyle médial permet de déterminer avec une bonne précision le point de pénétration du pédicule principal dans le muscle gracile; 5) La dissection complète du pédicule principal améliore la longueur disponible du lambeau musculaire.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abes M, Bourgeon Y, Graglia JC (1991) Reconstruction vaginale et périnéale aprés éxérèse pour cancer. Ann Chir Plast Esthet 36: 54–60

    Google Scholar 

  2. Bostwick J, Hill HL, Nahai F (1979) Repairs in the lower abdomen, groin, or perineum with myocutaneous or omental flap. Plast Reconstr Surg 63: 186–194

    Google Scholar 

  3. Cariou JL, Bouet JL, Schoofs M, Baudet J, Panconi B (1983) Notre expérience de la couverture des escarres ischiatiques par lambeaux musculo-cutanés. Ann Chir Plast Esthet 28: 337–47

    Google Scholar 

  4. Cormack GC, Lamberty BGH (1985) The blood supply of thigh skin. Plast Reconstr Surg 75: 342–54

    Google Scholar 

  5. Dargent D, Pegaz-Fiornet M (1987) L'utilisation du muscle droit interne dans la réparation des grands délabrements pelviens et périneaux chez la femme. Lyon Chir 83: 53–6

    Google Scholar 

  6. De Ranieri J, Crouet H, Andre M, Ollivier JM, Desdoits JM, Bouvet A, Souloy J (1985) Les lambeaux de droit interne dans la couverture des pertes de substance périnéale en chirurgie carcinologique. Presse Med 38: 1967–9

    Google Scholar 

  7. Gholam D, Trevidic P, Kleimann P, Hautefeuille P, Nicoletis C (1991) Le lambeau musculo-cutané de droit interne; bilan de 20 cas. Ann Chir Plast Esthet 36: 424–9

    Google Scholar 

  8. Giordano PA, Abbes M, Pequignot JP (1990) Gracilis blood supply: anatomical and clinical re-evaluation. Br J Plast Surg 43: 266–72

    Google Scholar 

  9. Gregoire R, Oberlin G (1977) Précis d'anatomie, 9e edn. JB Baillères, Paris

    Google Scholar 

  10. Harii K, Ohmori K, Sekiguchi J (1976) The free musculocutaneous flap. Plast Reconstr Surg 57: 294–303

    Google Scholar 

  11. Harii K, Ohmori K, Torii S (1976) Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. Plast Reconstr Surg 57: 133–43

    Google Scholar 

  12. Heath PM, Woods JE, Pobratz KC, Arnold MD, Irons GB (1984) Gracilis myocutaneous vaginal reconstruction. Mayo Clin Proc 59: 21–4

    Google Scholar 

  13. Heckler FR, Aldridge JE, Songcharoen S, Jabeley ME (1980) Muscle flaps and musculo-cutaneous flaps in the repair of urinary fistulas. Plast Reconstr Surg 66: 94–101

    Google Scholar 

  14. Iselin C, Graber P, Gumener R (1991) Lésion urétrale associée à un délabrement périnéal: reconstruction combinée immédiate par le lambeau musculo-cutané du gracilis. J Urol Paris 97: 199–202

    Google Scholar 

  15. Juricic M, Vaysse Ph, Visentin M, Guitard J, Moscovici J, Becue J, Juskiewenski S (1992) Muscle gracile chez l'homme. Bull Assoc Anat 76: 35–42

    Google Scholar 

  16. Kalisman M, Sharzer LA (1981) Anal sphincter reconstruction and perineal resurfacing with a gracilis myocutaneous flap. Dis Col Rectum 24: 529–31

    Google Scholar 

  17. Kauer Ch, Andourah A (1991) Complications périnéales et lambeau musculo-cutané de droit interne chez le paraplégique: a propos de dix neuf cas. Ann Chir Plast Esthet 36: 347–52

    Google Scholar 

  18. Lazorthes G (1971) Le système nerveux périphérique, 2e edn. Masson, Paris

    Google Scholar 

  19. Lesavoy MA, Dubrow TJ, Korn HN, Cedars MG, Castro DJ (1990) “Sensible” flap coverage of pressure sores in patients with myelomeningocele. Plast Reconstr Surg 85: 390–4

    Google Scholar 

  20. Mathes SJ, Alpert BS, Chang N (1982) Use of the muscle flap in chronic osteomyelitis: experimental and clinical correlation. Plast Reconstr Surg 69: 815–28

    Google Scholar 

  21. Mathes SJ, Feng LJ, Hunt TK (1983) Coverage of the infected wound. Ann Surg 198: 420–9

    Google Scholar 

  22. Mathes SJ, Nahai F (1981) Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 67: 177–87

    Google Scholar 

  23. Mathes SJ, Nahai F (1982) Clinical applications for muscle and musculocutaneous flaps. Mosby, St Louis

    Google Scholar 

  24. Mathes SJ, Nahai F, Vasconez LO (1978) Myocutaneous freeflaps transfer; anatomical and experimental considerations. Plast Reconstr Surg 62: 162–6

    Google Scholar 

  25. Michel-Bechet R (1967) La sphincteroplastie anale au moyen des droits interne. Presse Med 75: 977

    Google Scholar 

  26. McCraw JB, Dibell DG (1977) Experimental definition of independent myocutaneous vascular territories. Plast Reconstr Surg 60: 212–20

    Google Scholar 

  27. McCraw JB, Massey FM, Shanklin KD, Horton CE (1976) Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg 58: 176–183

    Google Scholar 

  28. Orticochea M (1972) The musculocutaneous flap method: an immediate and heroic substitute for the method of delay. Br J Plast Surg 25: 106–10

    Google Scholar 

  29. Paturet B (1951) Traité d'anatomie humaine. Masson, Paris

    Google Scholar 

  30. Pers M, Medgeysi S (1973) Pedicle muscle flaps and their application in the surgery of repair. Br J Plast Surg 26: 313–21

    Google Scholar 

  31. Rouffet F, Honnart F, Calmat A (1977) La vascularisation des muscles de la patte d'oie et ses applications chirurgicales. J Chir 114: 193–200

    Google Scholar 

  32. Rouviere H (1970) Anatomie humaine descriptive et topographique, tome II, 10e edn. Masson, Paris

    Google Scholar 

  33. Salmon M, Dor J (1933) Les artères des muscles des membres et du tronc. Masson, Paris

    Google Scholar 

  34. Testut L (1900) Anatomie humaine. Doin, Paris

    Google Scholar 

  35. Wheeless CR, McGibbon B, Dorsey JH, Maxwell P (1979) Gracilis myocutaneous flap in reconstruction of the vulva and female perineum. Obstet Gynecol 54: 97–102

    Google Scholar 

  36. Wingate GB, Friedland JA (1978) Repair of ischial pressure ulcers with gracilis myocutaneous island flaps. Plast Reconstr Surg 62: 245–8

    Google Scholar 

  37. Woods JE, Beart RW (1983) Reconstruction of nonhealing perineal wounds with gracilis muscle flaps. Ann Plast Surg 11: 513–6

    Google Scholar 

  38. Woods JE, Irons GB, Masson JK (1977) Use of muscular, musculocutaneous and omental flaps to reconstruct difficult defects. Plast Reconstr Surg 59: 191–9

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratoire d'Anatomie Appliquée, Faculté de Médecine Rangueil, Université Paul Sabatier, Toulouse III, 133, route de Narbonne, F-31062, Toulouse Cedex, France

    M Juricic, Ph Vaysse, J Guitard, J Moscovici, J Becue & S Juskiewenski

Authors
  1. M Juricic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ph Vaysse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Guitard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Moscovici
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J Becue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Juskiewenski
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Juricic, M., Vaysse, P., Guitard, J. et al. Anatomic basis for use of a gracilis muscle flap. Surg Radiol Anat 15, 163–168 (1993). https://doi.org/10.1007/BF01627695

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01627695

Key words

Search

Navigation