title: The free gracilis perforator flap: anatomical study and clinical refinements of a new perforator flap.
abstract: BACKGROUND
  The free gracilis perforator flap is a fascioadipocutaneous flap on the medial thigh, based on perforators of the main pedicle of the gracilis myocutaneous flap.
  
  
  METHODS
  An anatomical study was performed using 43 cadaver dissections. The vascular anatomy of the gracilis perforator flap with regard to myocutaneous and septocutaneous perforators was assessed. Clinical application was demonstrated in 14 cases.
  
  
  RESULTS
  Musculocutaneous perforators of the gracilis muscle pedicle were present in all dissections and were 0.5 mm or more in 93 percent. Septocutaneous perforators were found in 84 percent of the dissections, and perforators of 0.5 mm or more were found in 63 percent. Most musculocutaneous perforators were found in the anterior quarter of the muscle where the pedicle enters the gracilis muscle. A constant intramuscular anastomosis between the main and second vascular pedicles of the gracilis was demonstrated that allowed design of an extended gracilis perforator flap.
  
  
  CONCLUSIONS
  Successful clinical application in 14 cases confirmed vascular reliability. The gracilis perforator flap is a pliable, thin flap from the medial thigh that can be as large as 18 x 15 cm. The donor site is inconspicuous, and a functional gracilis muscle is preserved. By including a constant intramuscular anastomosis, it is possible to extend the territory of the free flap distally up to a length of 27 cm. Indications include reconstruction of cutaneous defects such as unstable scars or contractures. The medial thigh adipose tissue correlates well with the body mass index and thus can be used for breast reconstruction as a second choice if an abdominal perforator flap is not available.
authors.affiliation: Vogtareuth, Tuttlingen, and Frankfurt, Germany From the Department of Plastic, Reconstructive and Hand Surgery, Medical Centre Vogtareuth; Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery, Tuttlingen Hospital; and Department of Plastic, Reconstructive, and Hand Surgery, Markus Hospital.
authors.forename: Alberto
authors.initials: A
authors.lastname: Peek
authors.forename: Miriam
authors.initials: M
authors.lastname: Müller
authors.forename: Guido
authors.initials: G
authors.lastname: Ackermann
authors.forename: Klaus
authors.initials: K
authors.lastname: Exner
authors.forename: Steffen
authors.initials: S
authors.lastname: Baumeister
mesh_terms: D000125:Achilles Tendon / Q000601:surgery; D000328:Adult; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012501:Saphenous Vein / Q000033:anatomy & histology; D013524:Surgical Flaps / Q000098:blood supply; D013848:Thigh / Q000033:anatomy & histology* / Q000294:innervation / Q000601:surgery*