Surgical technique and clinical application of the transverse gracilis myocutaneous free flap

The unreliability of the distal skin component of the gracilis myocutaneous free flap has been frequently reported. To improve the reliability of the skin we orientated the cutaneous paddle in a transverse direction in the pr oximal third of the gracilis muscle, as first described by Yousif et al in 1993. Their anatomical studies showed that cutaneous branches of the domina nt proximal pedicle have a pronounced tendency to travel in a transverse di rection, supplying the skin anteriorly over the adductor longus and sartori us muscles and extending beyond the posterior margin of the gracilis muscle . We adopted this transverse design and transferred myocutaneous gracilis f laps measuring up to 17 x 9 cm. The transverse gracilis myocutaneous flap w as dissected in the subfascial plane to include the peri-gracilis fascia, w hich preserved the fascial vascular network and thus optimised skin-paddle perfusion. Ten transverse gracilis myocutaneous free flaps were performed o ver 3 years. Skin paddles ranged in size from 10 x 7 cm (70 cm(2)) to 17 x 9 cm ( 153 cm(2)) with a mean of 113.4 cm(2). Five defects were located in the head and neck region, three in the lower leg, one in the thigh and one in the thorax. Patients were followed for an average of 16.6 months (range: 6-46 months). Minor complications (donor-site wound dehiscence and flap-wo und-edge separation) occurred in four patients, however, all 10 flaps survi ved and healed with complete cutaneous survival. (C) 2001 The British Assoc iation of Plastic Surgeons.