title: [The transverse musculocutaneous gracilis free flap: Innovative autologous breast reconstruction].
abstract: BACKGROUND
  The transverse musculocutaneous gracilis free flap allows a wider range of indications in autologous breast reconstruction. They extend far beyond traditional dorsal, abdominal and gluteal flaps. The authors present their experience in using this innovative procedure.
  
  
  METHODS
  The cutaneous and adipose part of the flap consists in a horizontal ellipse centered on the gracilis muscle in the upper thigh. The distal part of the muscle is released without neither visual control nor additional incision. The flap vascular pedicle is microanastomosed to the recipient internal thoracic vessels in the third intercostal space. Eleven patients, with a mean age of 44 years (29-62) and a BMI of 24 (19-32) underwent this procedure. Surgery was performed on either one side (n=6) or two (n=5), in indications of immediate (n=5) or delayed reconstruction (n=6). The main operative parameters (time, vessel diameter, pedicle length, flap volume) as well as postoperative follow-up were studied.
  
  
  RESULTS
  Mean time of surgery was 4h33 (3-6 hours). Pedicle measured 6.2 cm (5-7.5) and diameter of the artery was 19 mm (15-30). Average weight of the flap was 344g (270-498). Two cases of partial necrosis occurred in the posterior cutaneous part of the flap (1cm(3) and 3 cm(3)). They were treated using controlled wound healing. Sequelae in the donor site proved minimal as the scar was placed in the crural crease and the gluteal fold. No major functional defect was noted after mean follow-up of six months.
  
  
  CONCLUSIONS
  The transverse musculocutaneous gracilis free flap allows natural and durable reconstruction while reducing cosmetic and functional sequelae in the donor site. It proves to be particularly useful in bilateral immediate reconstructions following skin-sparing mastectomy. This surgical option offers new opportunities to long-limbed women without abdominal excess wishing autologous breast reconstruction.
authors: Service de chirurgie plastique reconstructrice et esthétique, hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o)426, 67091 Strasbourg cedex, France. frederic.bodin@chru-strasbourg.fr
authors: F
authors: F
authors: Bodin
authors: T
authors: T
authors: Schohn
authors: J-C
authors: JC
authors: Lutz
authors: S
authors: S
authors: Zink
authors: A
authors: A
authors: Wilk
authors: C
authors: C
authors: Bruant Rodier
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001158:Arteries / Q000601:surgery; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D020858:Tissue and Organ Harvesting / Q000379:methods; D014945:Wound Healing / Q000502:physiology