Improving Skin Paddle Reliability and Muscle Gliding in Free Functional Gracilis Transfers

• Published in: Plastic and reconstructive surgery. Global open Vol. 12; no. 2; p. e5592
• Main Authors: Vaile, John R, Struble, Sarah L, Patel, Niki K, Janes, Lindsay E, Park, Eugene D, Levin, L Scott, Mendenhall, Shaun D
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2024; Wolters Kluwer
• Subjects: Hand; Ideas and Innovations
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000005592

Free functional muscle transfer is an attractive option within reconstructive surgery when seeking to restore critical muscle function. The gracilis muscle has long been utilized for this purpose due to its expendability and consistent anatomy. Historically, survival of the skin overlying the distal one-third of the myocutaneous gracilis flap has been unpredictable. To address this, the myofasciocutaneous technique was developed, with prior studies demonstrating improved distal skin paddle viability with this approach; however, the mechanism is poorly defined. This study aimed to understand what factors contribute to survival benefit in myofasciocutaneous gracilis flaps. Using cadaveric dissections followed by latex dye injections, we discuss the creation of a deep fascial sheath that contains a rich vascular network and permits adhesion-free excursion at the recipient site. This study advances our understanding of the myofasciocutaneous gracilis flap and provides wider clinical applicability in free functional muscle transfer.