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Gracilis perforator flap and extended gracilis perforator flap: New flaps for reconstruction of severe defects of the hand?

2006; Elsevier BV; Volume: 59; Issue: 9 Linguagem: Inglês

10.1016/j.bjps.2006.03.034

1878-0539

M. Müller, Michael Sauerbier, A. Peek,

Organ and Tissue Transplantation Research

The medial thigh represents a potential good donor area for muscle sparing perforator flaps. However, in the past only pedicled flaps from this area have been frequently used. Only the free gracilis muscle or musculocutaneous flap are widely spread flaps for defect coverage or functional muscle transplantation of the forearm and hand. Based on previous extensive anatomic studies of the gracilis angiosome and the medial thigh angiosome and subsequently the development of the gracilis perforator flap a new cadaver study was performed to extend the gracilis perforator flap twice as big (18×27 cm). Especially the intramuscular network of the gracilis muscle was examined. The anastomoses between the pedicles based on the superficial femoral artery and the deep femoral artery runs in 87% inside the gracilis muscle, strictly speaking in the anterior muscle rim. By integrating this intramuscular anastomosis in the gracilis perforator flap it almost leads to enlarge the flap double – size. We have entitled this flap the extended gracilis perforator flap. The gracilis perforator flap study as well as the development of the extended gracilis perforator flap are based on anatomic cadaver studies (N=42 specimens) with selective injections (methylene blue, red barium sulphate) and radiographic examinations. The results have been transformed into clinical practice. Indications for the new perforator flaps have been unilateral and bilateral breast reconstructions, unstable scars or chronic wounds so far. It is also possible to use these new types of free flaps, the gracilis perforator flap and the extended gracilis perforator flap, to cover large defects of the hand. Recently performed cases are demonstrated and discussed with established alternatives such as cutaneous, fascial and muscle flaps.