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Zhang C, Yang X, Bi H. Application of depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration. BMC Surg 2022; 22:304. [PMID: 35933336 PMCID: PMC9357311 DOI: 10.1186/s12893-022-01755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pelvic exenteration is a radical surgery performed in selected patients with locally advanced or recurrent pelvic malignancy. It involves radical en bloc resection of the adjacent anatomical structures affected by the tumor. The authors sought to evaluate the clinical application of a depithelized gracilis adipofascial flap for pelvic floor reconstruction after pelvic exenteration. Methods A total of 31 patients who underwent pelvic floor reconstruction with a gracilis adipofascial flap after pelvic exenterationat Peking University Third Hospital from 2014 to 2022 were enrolled in the study. The postoperative follow-up durations varied from 4 to 12 months. Results The survival rate of the flap was 96.77% with partial flap necrosis in one case. The total incidence of postoperative complications associated with the flap was 25.81%, with an incidence of 6.45% in the donor site and 19.35% in the recipient site. All complications were early complications, including postoperative infection and flap necrosis. All patients recovered after treatments, including anti-infectives, dressing change, debridement, and local flap repair. Long-term follow-up showed good outcomes without flap-related complications. Conclusions A depithelized gracilis adipofascial flap can be applied for pelvic floor reconstruction after pelvic exenteration. The flap is an ideal and reliable choice for pelvic floor reconstruction with few complications, an elevated survival rate, sufficient volume, and mild effects on the function of the donor site.
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Affiliation(s)
- Chen Zhang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongsen Bi
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Gulyaev D, Begjanyan A, Kaurova T, Belov I, Kurnosov I. Anatomical and topographical features of the gracilis muscle of the thigh from the position of using it for autotransplantation. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.21.119123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Autotransplantation of a free flap of the gracilis muscle is currently actively used in reconstructive surgery for persistent prosoplegia, injuries of the brachial plexus, for plastic closure of defects in the upper lip, and in the treatment of pelvic sepsis. This study provides important information about the anatomical features of the gracilis muscle and its neurovascular bundle, which are highly variable. The study of the anatomical and topographic features of this fine thigh muscle was carried out on a sectional study of 25 corpses of both sexes, 50 lower limbs. The present study demonstrates that the median value of the total length of m. Gracilis, the length of its muscular part, as well as the length of the tendon were 452.25 (439.7; 462.0); 225.3(208.1;239.0); 230.5 (213.0; 244.4) mm, respectively. The number of vascular pedicles included in m. Gracilis, ranged from 1 to 5. In 86% of the cases, the deep femoral artery formed the dominant vascular pedicle, and in 14% of cases, it was the medial circumflex artery. Small secondary vascular pedicles originated from the descending genicular artery or the anterior branch of the obturator arter: from the basin of the internal iliac artery. The length of the main feeding artery varied from 76 to 134 mm, the median value was 100.5(90;110) mm, and its diameter ranged from 1.4 to 2.1 mm (M = 1.9(1.8;2, 0) mm. The innervation of the fine muscle of the thigh was carried out by the anterior branch of the obturator nerve, which in 82% of the cases was represented by a single trunk; less often a loose type of structure was observed. The proper nerve was located at a distance of 108.5 (96; 117) mm from the origin of the muscle; its diameter was 2.1 (1.9; 2.2) mm. Knowledge of the topographic and anatomical relationships of the neurovascular bundle with the surrounding formations, variants of its individual anatomical variability are the key to successful reconstructive surgery.
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Tuluy Y, Bali Z, Unsal M, Parspanci A, Yoleri L, Kececi Y. Free gracilis muscle flap: Variations of obturator nerve. TURKISH JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.4103/tjps.tjps_67_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The innervated gracilis muscle for microsurgical functional lip reconstruction: review of the literature. Ann Plast Surg 2015; 74:204-9. [PMID: 23804028 DOI: 10.1097/sap.0b013e3182920c99] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstruction of the lower and upper lip should meet both aesthetic and functional requirements, whenever possible. Achievement of these goals presents a major challenge particularly in extensive lip defects requiring microsurgical reconstruction. Successful reconstructive outcomes have been reported using free fasciocutaneous flaps such as composite radial forearm flap or anterolateral thigh flap in conjunction with static tendon slings. In recent years, neurovascular gracilis muscle transfer has been introduced in hopes to overcome noncontractile properties of these flaps and to restore oral competence by muscle contractility. This article reviews the available data on the innervated gracilis muscle transfer for functional lip reconstruction. Tips and techniques gleaned from all of the current literature are discussed.
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Amin K, Dempsey M, Ghali S, Grobbelaar A. Saving grace: distally pedicled gracilis muscular flap in lower limb salvage. BMJ Case Rep 2014; 2014:bcr-2014-205486. [PMID: 25085952 DOI: 10.1136/bcr-2014-205486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
During the 1970s, the incidence of limb amputation following surgery for sarcoma excision was as high as 50%. Two important developments have led to modern day limb salvage, namely chemotherapy and precision imaging techniques. We present a case of limb salvage in a patient with osteosarcoma plagued with recurrent infection after prosthetic revision. We discuss the use of the distally based pedicled gracilis muscular flap, which has little mention as a reconstructive option for defects around the knee.
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Affiliation(s)
- Kavit Amin
- Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Marlese Dempsey
- Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Shadi Ghali
- Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Adriaan Grobbelaar
- Plastic & Reconstructive Surgery Department, Royal Free Hampstead NHS Foundation Trust, Royal Free Hospital, London, UK
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Shih PK, Cheng HT, Wu CI, Chang SCN, Chen HC, Chen HH. Management of Infected Groin Wounds after Vascular Surgery. Surg Infect (Larchmt) 2013; 14:325-30. [PMID: 23488679 DOI: 10.1089/sur.2011.123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pin-Keng Shih
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Tang Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chao-I Wu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Sophia Chia-Ning Chang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Han Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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Whitaker IS, Karavias M, Shayan R, le Roux CM, Rozen WM, Corlett RJ, Taylor GI, Ashton MW. The gracilis myocutaneous free flap: a quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction. PLoS One 2012; 7:e36367. [PMID: 22590534 PMCID: PMC3348940 DOI: 10.1371/journal.pone.0036367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/05/2012] [Indexed: 12/11/2022] Open
Abstract
Background Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes. Methods Twenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the ‘Lymphatic Vessel Analysis Protocol’ (LVAP) plug-in for Image J® software. Results We found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35×19 cm and 34×10 cm, respectively. Conclusion Our findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a ‘T’ or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay.
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Affiliation(s)
- Iain S. Whitaker
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
- Swansea University College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Maria Karavias
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - Ramin Shayan
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - Cara Michelle le Roux
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - Warren M. Rozen
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - Russell J. Corlett
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - G. Ian Taylor
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
| | - Mark W. Ashton
- The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Singh H, Kaur R, Gupta N. Morphometric Study of Gracilis Muscle and its Role in Clinical Reconstruction. J ANAT SOC INDIA 2011. [DOI: 10.1016/s0003-2778(11)80027-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Behan FC, Paddle A, Rozen WM, Ye X, Speakman D, Findlay MW, Henderson MA. Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects. ANZ J Surg 2011; 83:942-7. [DOI: 10.1111/j.1445-2197.2011.05790.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Assessment of Donor-Site Morbidity following Rectus Femoris Harvest for Infrainguinal Reconstruction. Plast Reconstr Surg 2010; 126:933-940. [DOI: 10.1097/prs.0b013e3181e604a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Update: advances in surgery. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.05066.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Update: advances in surgery. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04899.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Macchi V, Vigato E, Porzionato A, Tiengo C, Stecco C, Parenti A, Morra A, Bassetto F, Mazzoleni F, De Caro R. The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study. Clin Anat 2008; 21:696-704. [PMID: 18773484 DOI: 10.1002/ca.20685] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- V Macchi
- Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Padova, Italy
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