title: Modifications to extend the transverse upper gracilis flap in breast reconstruction:  clinical series and results.
abstract: BACKGROUND
  The transverse myocutaneous gracilis flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the flap with two types of modifications to increase flap volume: an extended and a vertical extended flap. In this article, they discuss the different operative techniques and present a clinical series of both flap types.
  
  
  METHODS
  A retrospective review of all patients undergoing either flap modification under the senior author (M.S.-C.) was performed. Data collated included pedicle artery and vein diameters, flap weight, and patient complications.
  
  
  RESULTS
  Twenty-four transverse myocutaneous gracilis flaps were performed: 12 extended (seven patients) and 12 vertical flaps (six patients). The vertical group trended to have greater flap weights than the extended group. Mean flap weight was 385.75 g (range, 181 to 750 g) for the extended group and 469.75 g (range, 380 to 605 g) for the vertical group (p = 0.06). Mean arterial diameter of the medial circumflex artery was 1.9 mm (range, 1.5 to 2.0 mm), mean venous diameter was 2.4 mm (range, 2.0 to 3.5 mm), and mean pedicle length was 6.8 cm (range, 6.0 to 7.0 cm). All donor sites were closed primarily. Complications included seroma (n = 1), wound dehiscence (n = 2), and partial flap loss (n = 2).
  
  
  CONCLUSIONS
  Modifications of the transverse myocutaneous gracilis flap increase flap volume and can be useful in patients who do not wish to have abdomen, buttock, or back scars. Donor-site scars can be concealed, and patients have the added benefit of a thigh lift. Complications are comparable to those found with other reconstructive options.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Dallas, Texas; and Lyon, France From the University of Texas Southwestern Medical Center and the Department of Plastic Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, University of Lyon.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
authors.forename: Corrine
authors.initials: C
authors.lastname: Wong
authors.forename: Georgette
authors.initials: G
authors.lastname: Oni
authors.forename: Munique
authors.initials: M
authors.lastname: Maia
authors.forename: Andrew
authors.initials: A
authors.lastname: Trussler
authors.forename: Ali
authors.initials: A
authors.lastname: Mojallal
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome