title: The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction.
abstract: BACKGROUND
  Autologous breast reconstruction is predominantly performed using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps. However, some patients are not suitable candidates for flaps from the lower abdomen. The transverse skin island of the gracilis muscle presents an additional option, as it includes tissue from the posterior upper thigh/lower buttock and thus delivers the amount of tissue necessary for breast reconstruction.
  
  
  METHODS
  In 2007, the authors' unit performed 73 free flaps for breast reconstruction subsequent to carcinoma, implant-related capsular fibrosis, and breast asymmetry. The transverse myocutaneous gracilis flap was used 32 times. The ventral margin was the greater saphenous vein, and the posterior margin was the midline of the inferior gluteal fold. The skin island could be harvested to a width of up to 30 cm and a height of up to 10 cm. The donor site was closed primarily.
  
  
  RESULTS
  Thirty-two flaps were performed in 20 patients. Mean follow-up was 6 months. Mean operating time was 220 minutes for unilateral and 325 minutes for bilateral cases. All flaps and donor sites healed uneventfully. An initially described "tight feeling" at the thigh ceased after 2 to 3 weeks. Persistent hypesthesia of the dorsal thigh was not noted. A major asymmetry of the thigh in unilateral transplantations was not apparent. After 6 months, all flaps were soft.
  
  
  CONCLUSIONS
  The transverse myocutaneous gracilis flap is a safe, fast flap for reconstruction after benign and malignant breast disease. It combines a constant vascular pedicle with soft subcutaneous tissue that has breast-like characteristics.
authors.affiliation: Bielefeld, Germany From the Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, and the Department of Gynecology and Obstetrics, Städtische Kliniken Mitte.
authors.forename: Hisham
authors.initials: H
authors.lastname: Fansa
authors.forename: Steffen
authors.initials: S
authors.lastname: Schirmer
authors.forename: Imke C
authors.initials: IC
authors.lastname: Warnecke
authors.forename: Angelika
authors.initials: A
authors.lastname: Cervelli
authors.forename: Onno
authors.initials: O
authors.lastname: Frerichs
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery; D044584:Carcinoma, Ductal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000592:standards; D008408:Mastectomy; D008875:Middle Aged; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery