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Gottfried Wechselberger - One of the best experts on this subject based on the ideXlab platform.
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Clinical Applications of the Transverse Musculocutaneous Gracilis Flap for Secondary Breast Reconstruction after Simple Mastectomy.
Plastic and reconstructive surgery, 2016Co-Authors: Gottfried Wechselberger, Heike Traintinger, Lorenz Larcher, Elisabeth Russe, Monika Edelbauer, Florian EnsatAbstract:In secondary autologous breast reconstruction, the current standard is a Flap derived from the lower abdomen or the back. If these donor sites are not available because of lack of tissue, prior operations, or simply the patient's desire to avoid these donor sites, the authors use the transverse musculocutaneous Gracilis Flap if feasible. The authors retrospectively evaluated only patients where secondary autologous breast reconstruction was performed with a transverse musculocutaneous Gracilis Flap because of the prior mentioned reasons. Indications, limitations, advantages, and technique are discussed by sharing the authors' experience in 23 patients using 26 transverse musculocutaneous Gracilis Flaps. No Flap loss could be observed in this series. In four patients, minimal lateral skin necrosis could easily be managed by débridement and primary wound closure. In 12 cases, subsequent lipofilling was performed for a better breast shape. On average, patient satisfaction was high. Secondary reconstruction after simple mastectomy using the transverse musculocutaneous Gracilis Flap requires a little more experience than after skin-sparing mastectomy but, especially combined with later lipofilling, can lead to an optimally shaped breast in selected patients with substantial skin laxity and fat distribution at the inner thigh. Therapeutic, IV.
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clinical applications of the transverse musculocutaneous Gracilis Flap for secondary breast reconstruction after simple mastectomy
Plastic and Reconstructive Surgery, 2016Co-Authors: Gottfried Wechselberger, Heike Traintinger, Lorenz Larcher, Elisabeth Russe, Monika Edelbauer, Florian EnsatAbstract:Background In secondary autologous breast reconstruction, the current standard is a Flap derived from the lower abdomen or the back. If these donor sites are not available because of lack of tissue, prior operations, or simply the patient's desire to avoid these donor sites, the authors use the transverse musculocutaneous Gracilis Flap if feasible. Methods The authors retrospectively evaluated only patients where secondary autologous breast reconstruction was performed with a transverse musculocutaneous Gracilis Flap because of the prior mentioned reasons. Indications, limitations, advantages, and technique are discussed by sharing the authors' experience in 23 patients using 26 transverse musculocutaneous Gracilis Flaps. Results No Flap loss could be observed in this series. In four patients, minimal lateral skin necrosis could easily be managed by debridement and primary wound closure. In 12 cases, subsequent lipofilling was performed for a better breast shape. On average, patient satisfaction was high. Conclusions Secondary reconstruction after simple mastectomy using the transverse musculocutaneous Gracilis Flap requires a little more experience than after skin-sparing mastectomy but, especially combined with later lipofilling, can lead to an optimally shaped breast in selected patients with substantial skin laxity and fat distribution at the inner thigh. Clinical question/level of evidence Therapeutic, IV.
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Transverse upper Gracilis Flap for breast reconstruction.
Plastic and Reconstructive Surgery, 2012Co-Authors: Gottfried Wechselberger, Thomas SchoellerAbstract:The transverse myocutaneous Gracilis Flap (TMG, TUG) is a major evolution in breast reconstruction. Systematic clinical application for breast reconstruction started in the early beginning of the new millennium after discovering the major advantages of this musculo-adipo-cutaneous free Flap. Low donor-site morbidity, constant anatomy, and easy two-team approach are a few arguments for considering this valuable tissue source for breast reconstruction. This chapter is a systematic workup of the Flap, including practical surgical tips and case presentations.
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donor site morbidity of the transverse musculocutaneous Gracilis Flap in autologous breast reconstruction short term and long term results
Plastic and Reconstructive Surgery, 2011Co-Authors: Petra Pülzl, Thomas Schoeller, Kristin Kleewein, Gottfried WechselbergerAbstract:BACKGROUND The authors have used the transverse musculocutaneous Gracilis Flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients. METHODS Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous Gracilis Flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the Gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons. RESULTS To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral Gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again. CONCLUSIONS The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous Gracilis Flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Donor-site morbidity of the transverse musculocutaneous Gracilis Flap in autologous breast reconstruction: short-term and long-term results.
Plastic and reconstructive surgery, 2011Co-Authors: Petra Pülzl, Thomas Schoeller, Kristin Kleewein, Gottfried WechselbergerAbstract:The authors have used the transverse musculocutaneous Gracilis Flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients. Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous Gracilis Flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the Gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons. To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral Gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again. The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous Gracilis Flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity. Therapeutic, IV.
Thomas Schoeller - One of the best experts on this subject based on the ideXlab platform.
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Transverse musculocutaneous Gracilis Flap for treatment of capsular contracture in tertiary breast reconstruction.
Annals of plastic surgery, 2015Co-Authors: Petra Pülzl, George M. Huemer, Thomas SchoellerAbstract:Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears. We performed 52 deepithelialized free transverse musculocutaneous Gracilis (TMG) Flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG Flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG Flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG Flap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry. The advantages of the TMG Flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation.
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Transverse upper Gracilis Flap for breast reconstruction.
Plastic and Reconstructive Surgery, 2012Co-Authors: Gottfried Wechselberger, Thomas SchoellerAbstract:The transverse myocutaneous Gracilis Flap (TMG, TUG) is a major evolution in breast reconstruction. Systematic clinical application for breast reconstruction started in the early beginning of the new millennium after discovering the major advantages of this musculo-adipo-cutaneous free Flap. Low donor-site morbidity, constant anatomy, and easy two-team approach are a few arguments for considering this valuable tissue source for breast reconstruction. This chapter is a systematic workup of the Flap, including practical surgical tips and case presentations.
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Breast and chest wall reconstruction with the transverse musculocutaneous Gracilis Flap in Poland syndrome.
Plastic and reconstructive surgery, 2012Co-Authors: George M. Huemer, Petra Puelzl, Thomas SchoellerAbstract:Poland syndrome is a complex chest wall deformity with unilateral hypoplasia of the breast and pectoralis muscle, with a missing anterior axillary fold in its most common form. The authors report their combined experience and technique with the transverse myocutaneous Gracilis Flap to reconstruct the chest wall and breast either alone or simultaneously. Between June of 2004 and July of 2010, 11 patients (two male patients) were operated on and 14 Flaps were transplanted. The authors found that the transverse myocutaneous Gracilis Flap proved to be a very valuable microsurgical alternative for reconstructing the chest wall and female breast in Poland syndrome with autologous tissue. The Flap provides the surgeon maximal freedom of Flap insetting for optimal symmetry together with a very inconspicuous donor site regardless of unilateral or bilateral harvesting.
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donor site morbidity of the transverse musculocutaneous Gracilis Flap in autologous breast reconstruction short term and long term results
Plastic and Reconstructive Surgery, 2011Co-Authors: Petra Pülzl, Thomas Schoeller, Kristin Kleewein, Gottfried WechselbergerAbstract:BACKGROUND The authors have used the transverse musculocutaneous Gracilis Flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients. METHODS Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous Gracilis Flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the Gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons. RESULTS To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral Gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again. CONCLUSIONS The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous Gracilis Flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Donor-site morbidity of the transverse musculocutaneous Gracilis Flap in autologous breast reconstruction: short-term and long-term results.
Plastic and reconstructive surgery, 2011Co-Authors: Petra Pülzl, Thomas Schoeller, Kristin Kleewein, Gottfried WechselbergerAbstract:The authors have used the transverse musculocutaneous Gracilis Flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients. Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous Gracilis Flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the Gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons. To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral Gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again. The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous Gracilis Flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity. Therapeutic, IV.
Corrine Wong - One of the best experts on this subject based on the ideXlab platform.
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modifications to extend the transverse upper Gracilis Flap in breast reconstruction clinical series and results
Plastic and Reconstructive Surgery, 2012Co-Authors: Michel Saintcyr, Corrine Wong, Georgette Oni, Munique Maia, Andrew P TrusslerAbstract:Background:The transverse myocutaneous Gracilis Flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the Flap with two types of modifications to increase Flap volume: an extended and a vertical extended Flap. In
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Modifications to extend the transverse upper Gracilis Flap in breast reconstruction: Clinical series and results
Plastic and reconstructive surgery, 2012Co-Authors: Michel Saint-cyr, Corrine Wong, Georgette Oni, Munique Maia, Andrew P Trussler, Ali Mojallal, Rod J. RohrichAbstract:The transverse myocutaneous Gracilis Flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the Flap with two types of modifications to increase Flap volume: an extended and a vertical extended Flap. In this article, they discuss the different operative techniques and present a clinical series of both Flap types. A retrospective review of all patients undergoing either Flap modification under the senior author (M.S.-C.) was performed. Data collated included pedicle artery and vein diameters, Flap weight, and patient complications. Twenty-four transverse myocutaneous Gracilis Flaps were performed: 12 extended (seven patients) and 12 vertical Flaps (six patients). The vertical group trended to have greater Flap weights than the extended group. Mean Flap weight was 385.75 g (range, 181 to 750 g) for the extended group and 469.75 g (range, 380 to 605 g) for the vertical group (p = 0.06). Mean arterial diameter of the medial circumflex artery was 1.9 mm (range, 1.5 to 2.0 mm), mean venous diameter was 2.4 mm (range, 2.0 to 3.5 mm), and mean pedicle length was 6.8 cm (range, 6.0 to 7.0 cm). All donor sites were closed primarily. Complications included seroma (n = 1), wound dehiscence (n = 2), and partial Flap loss (n = 2). Modifications of the transverse myocutaneous Gracilis Flap increase Flap volume and can be useful in patients who do not wish to have abdomen, buttock, or back scars. Donor-site scars can be concealed, and patients have the added benefit of a thigh lift. Complications are comparable to those found with other reconstructive options. Therapeutic, III.
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The extended transverse musculocutaneous Gracilis Flap: vascular anatomy and clinical implications.
Annals of plastic surgery, 2011Co-Authors: Corrine Wong, Andrew P Trussler, Ali Mojallal, Steven H. Bailey, Michel Saint-cyrAbstract:BACKGROUND: The transverse musculocutaneous Gracilis (TMG) Flap has been used in autologous breast reconstruction, but disadvantages include a small Flap volume; therefore, it is only used in small-to-moderate breast reconstructions. We investigated the vascular territory of this Flap and the possibility of extending its dimensions. METHODS: Ten circumferential thigh adipocutaneous Flaps attached to the Gracilis muscle were harvested from adult cadavers. The following parameters were recorded: diameter and length of pedicles, distance of pedicles from pubis, and number and locations of cutaneous perforators. The major pedicles were injected with contrast and subjected to 3-dimensional computed tomography scanning. Images were viewed using both General Electrics and TeraRecon systems, and the vascular territories were measured. Flaps were then incised to include only tissue that was perfused with contrast, and measured for weight and volume. RESULTS: The major pedicle had a mean length of 6.7 cm, diameter of 2.2 mm, and distance from pubis of 8.6 cm. There was a mean of 4.3 cutaneous perforators associated with this Flap. Three-dimensional images from contrast injection of the major pedicle showed a cutaneous vascular territory that extended more posteriorly than anteriorly, and had a vertical component. Tissue perfused with contrast had a mean weight of 573 g and volume of 617 mL. Two clinical cases were included to show applications of the extended TMG Flap. CONCLUSION: The dimensions of a TMG Flap can be increased horizontally (superoposterior thigh) as well as vertically. The vertical portion can be harvested either by undermining the skin inferior to the lower transverse skin incision or by raising a trilobed skin paddle to harvest even more tissue from the medial thigh.
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The transverse upper Gracilis Flap for breast reconstruction following liposuction of the thigh.
Microsurgery, 2010Co-Authors: Michel Saint-cyr, Arash Shirvani, Corrine WongAbstract:A particular Flap with rising prominence in breast reconstruction is the transverse upper Gracilis (TUG) Flap. With the increasing prevalence of patients opting for various forms of elective liposuctions, breast reconstruction with Flaps has necessitated a more meticulous yet perhaps more flexible screening for potential donor sites. We present a case of a bilateral breast reconstruction using TUG Flaps in a patient with a previous history of liposuction to her abdomen and thighs. The dimensions of the TUG Flaps were 7 × 31 cm². The patient did not undergo any Flap or donor site complications. We speculate that perhaps much of the tissue and muscle in the medial thigh region is more robust than previously thought and that there is high potential for neo-vascularization in the thigh region following a liposuction. Accordingly, we advocate the effective use of the TUG Flap for breast reconstruction in spite of previous liposuctions to the thighs.
Andrew P Trussler - One of the best experts on this subject based on the ideXlab platform.
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modifications to extend the transverse upper Gracilis Flap in breast reconstruction clinical series and results
Plastic and Reconstructive Surgery, 2012Co-Authors: Michel Saintcyr, Corrine Wong, Georgette Oni, Munique Maia, Andrew P TrusslerAbstract:Background:The transverse myocutaneous Gracilis Flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the Flap with two types of modifications to increase Flap volume: an extended and a vertical extended Flap. In
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Modifications to extend the transverse upper Gracilis Flap in breast reconstruction: Clinical series and results
Plastic and reconstructive surgery, 2012Co-Authors: Michel Saint-cyr, Corrine Wong, Georgette Oni, Munique Maia, Andrew P Trussler, Ali Mojallal, Rod J. RohrichAbstract:The transverse myocutaneous Gracilis Flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the Flap with two types of modifications to increase Flap volume: an extended and a vertical extended Flap. In this article, they discuss the different operative techniques and present a clinical series of both Flap types. A retrospective review of all patients undergoing either Flap modification under the senior author (M.S.-C.) was performed. Data collated included pedicle artery and vein diameters, Flap weight, and patient complications. Twenty-four transverse myocutaneous Gracilis Flaps were performed: 12 extended (seven patients) and 12 vertical Flaps (six patients). The vertical group trended to have greater Flap weights than the extended group. Mean Flap weight was 385.75 g (range, 181 to 750 g) for the extended group and 469.75 g (range, 380 to 605 g) for the vertical group (p = 0.06). Mean arterial diameter of the medial circumflex artery was 1.9 mm (range, 1.5 to 2.0 mm), mean venous diameter was 2.4 mm (range, 2.0 to 3.5 mm), and mean pedicle length was 6.8 cm (range, 6.0 to 7.0 cm). All donor sites were closed primarily. Complications included seroma (n = 1), wound dehiscence (n = 2), and partial Flap loss (n = 2). Modifications of the transverse myocutaneous Gracilis Flap increase Flap volume and can be useful in patients who do not wish to have abdomen, buttock, or back scars. Donor-site scars can be concealed, and patients have the added benefit of a thigh lift. Complications are comparable to those found with other reconstructive options. Therapeutic, III.
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Gracilis transposition Flap for repair of an acquired rectovaginal fistula in a pediatric patient
Journal of pediatric surgery, 2011Co-Authors: Hannah G. Piper, Andrew P Trussler, David T SchindelAbstract:Acquired rectovaginal fistulas in the pediatric population are relatively rare but are often difficult to treat. We describe a young girl who acquired a neorectovaginal fistula after a repeat pull-through procedure for Hirschsprung's disease. Durable repair of the fistula was accomplished with a Gracilis transposition Flap, providing a well-vascularized muscle buttress between the neorectum and vagina. To our knowledge, this is the first report of a Gracilis Flap in a pediatric patient with an acquired fistula and should be considered for this complication after pull-through for Hirschsprung's as well as for other perineal fistulas such as those acquired after trauma, infection, or in the setting of inflammatory bowel disease.
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The extended transverse musculocutaneous Gracilis Flap: vascular anatomy and clinical implications.
Annals of plastic surgery, 2011Co-Authors: Corrine Wong, Andrew P Trussler, Ali Mojallal, Steven H. Bailey, Michel Saint-cyrAbstract:BACKGROUND: The transverse musculocutaneous Gracilis (TMG) Flap has been used in autologous breast reconstruction, but disadvantages include a small Flap volume; therefore, it is only used in small-to-moderate breast reconstructions. We investigated the vascular territory of this Flap and the possibility of extending its dimensions. METHODS: Ten circumferential thigh adipocutaneous Flaps attached to the Gracilis muscle were harvested from adult cadavers. The following parameters were recorded: diameter and length of pedicles, distance of pedicles from pubis, and number and locations of cutaneous perforators. The major pedicles were injected with contrast and subjected to 3-dimensional computed tomography scanning. Images were viewed using both General Electrics and TeraRecon systems, and the vascular territories were measured. Flaps were then incised to include only tissue that was perfused with contrast, and measured for weight and volume. RESULTS: The major pedicle had a mean length of 6.7 cm, diameter of 2.2 mm, and distance from pubis of 8.6 cm. There was a mean of 4.3 cutaneous perforators associated with this Flap. Three-dimensional images from contrast injection of the major pedicle showed a cutaneous vascular territory that extended more posteriorly than anteriorly, and had a vertical component. Tissue perfused with contrast had a mean weight of 573 g and volume of 617 mL. Two clinical cases were included to show applications of the extended TMG Flap. CONCLUSION: The dimensions of a TMG Flap can be increased horizontally (superoposterior thigh) as well as vertically. The vertical portion can be harvested either by undermining the skin inferior to the lower transverse skin incision or by raising a trilobed skin paddle to harvest even more tissue from the medial thigh.
Michel Saint-cyr - One of the best experts on this subject based on the ideXlab platform.
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Modifications to extend the transverse upper Gracilis Flap in breast reconstruction: Clinical series and results
Plastic and reconstructive surgery, 2012Co-Authors: Michel Saint-cyr, Corrine Wong, Georgette Oni, Munique Maia, Andrew P Trussler, Ali Mojallal, Rod J. RohrichAbstract:The transverse myocutaneous Gracilis Flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the Flap with two types of modifications to increase Flap volume: an extended and a vertical extended Flap. In this article, they discuss the different operative techniques and present a clinical series of both Flap types. A retrospective review of all patients undergoing either Flap modification under the senior author (M.S.-C.) was performed. Data collated included pedicle artery and vein diameters, Flap weight, and patient complications. Twenty-four transverse myocutaneous Gracilis Flaps were performed: 12 extended (seven patients) and 12 vertical Flaps (six patients). The vertical group trended to have greater Flap weights than the extended group. Mean Flap weight was 385.75 g (range, 181 to 750 g) for the extended group and 469.75 g (range, 380 to 605 g) for the vertical group (p = 0.06). Mean arterial diameter of the medial circumflex artery was 1.9 mm (range, 1.5 to 2.0 mm), mean venous diameter was 2.4 mm (range, 2.0 to 3.5 mm), and mean pedicle length was 6.8 cm (range, 6.0 to 7.0 cm). All donor sites were closed primarily. Complications included seroma (n = 1), wound dehiscence (n = 2), and partial Flap loss (n = 2). Modifications of the transverse myocutaneous Gracilis Flap increase Flap volume and can be useful in patients who do not wish to have abdomen, buttock, or back scars. Donor-site scars can be concealed, and patients have the added benefit of a thigh lift. Complications are comparable to those found with other reconstructive options. Therapeutic, III.
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The extended transverse musculocutaneous Gracilis Flap: vascular anatomy and clinical implications.
Annals of plastic surgery, 2011Co-Authors: Corrine Wong, Andrew P Trussler, Ali Mojallal, Steven H. Bailey, Michel Saint-cyrAbstract:BACKGROUND: The transverse musculocutaneous Gracilis (TMG) Flap has been used in autologous breast reconstruction, but disadvantages include a small Flap volume; therefore, it is only used in small-to-moderate breast reconstructions. We investigated the vascular territory of this Flap and the possibility of extending its dimensions. METHODS: Ten circumferential thigh adipocutaneous Flaps attached to the Gracilis muscle were harvested from adult cadavers. The following parameters were recorded: diameter and length of pedicles, distance of pedicles from pubis, and number and locations of cutaneous perforators. The major pedicles were injected with contrast and subjected to 3-dimensional computed tomography scanning. Images were viewed using both General Electrics and TeraRecon systems, and the vascular territories were measured. Flaps were then incised to include only tissue that was perfused with contrast, and measured for weight and volume. RESULTS: The major pedicle had a mean length of 6.7 cm, diameter of 2.2 mm, and distance from pubis of 8.6 cm. There was a mean of 4.3 cutaneous perforators associated with this Flap. Three-dimensional images from contrast injection of the major pedicle showed a cutaneous vascular territory that extended more posteriorly than anteriorly, and had a vertical component. Tissue perfused with contrast had a mean weight of 573 g and volume of 617 mL. Two clinical cases were included to show applications of the extended TMG Flap. CONCLUSION: The dimensions of a TMG Flap can be increased horizontally (superoposterior thigh) as well as vertically. The vertical portion can be harvested either by undermining the skin inferior to the lower transverse skin incision or by raising a trilobed skin paddle to harvest even more tissue from the medial thigh.
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The transverse upper Gracilis Flap for breast reconstruction following liposuction of the thigh.
Microsurgery, 2010Co-Authors: Michel Saint-cyr, Arash Shirvani, Corrine WongAbstract:A particular Flap with rising prominence in breast reconstruction is the transverse upper Gracilis (TUG) Flap. With the increasing prevalence of patients opting for various forms of elective liposuctions, breast reconstruction with Flaps has necessitated a more meticulous yet perhaps more flexible screening for potential donor sites. We present a case of a bilateral breast reconstruction using TUG Flaps in a patient with a previous history of liposuction to her abdomen and thighs. The dimensions of the TUG Flaps were 7 × 31 cm². The patient did not undergo any Flap or donor site complications. We speculate that perhaps much of the tissue and muscle in the medial thigh region is more robust than previously thought and that there is high potential for neo-vascularization in the thigh region following a liposuction. Accordingly, we advocate the effective use of the TUG Flap for breast reconstruction in spite of previous liposuctions to the thighs.
