title: Extending the use of the gracilis muscle flap in perineal reconstruction surgery.
abstract: Reconstruction of the perineum is required following oncological resections. Plastic surgical techniques can be used to restore the aesthetics and function of the perineum. The gracilis myocutaneous flap provides a substantial skin paddle, with minimal donor site morbidity. The flap is pedicled on a perforator from the medial circumflex femoral artery, giving it limited reach across the perineum. Tunnelling the flap under the adductor longus muscle may free up more of the arterial pedicle, increasing its reach. On three female cadavers, bilateral gracilis flaps were raised in the standard surgical manner, giving six flaps in total. With the flaps pedicled across the perineum, the distance from the tip of each flap was measured to the anterior superior iliac spine (ASIS). The flaps were then tunnelled under the adductor longus muscle. The distances to the ASIS were measured again. The average pedicle length was greater than 7 cm. Tunnelling the flap under the adductor longus muscle increased the reach by more than 4 cm on average. Cadaveric dissection has shown that tunnelling of the flap in a novel way increase its reach across the perineum. This additional flexibility improves its use clinically and is of benefit to plastic surgeons operating in perineal reconstruction.
authors.affiliation: Department of Plastic Surgery, St John's Hospital, Howden Road West, Howden, Livingston, West Lothian, Scotland, EH54 6PP, United Kingdom. Electronic address: Stephen_goldie@hotmail.com.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Goldie
authors.affiliation: Department of Plastic Surgery, St John's Hospital, Howden Road West, Howden, Livingston, West Lothian, Scotland, EH54 6PP, United Kingdom.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Almasharqah
authors.affiliation: Laboratory of Human Anatomy, School of Life Sciences, University Avenue, University of Glasgow, Glasgow, Scotland, G12 8QQ, United Kingdom; Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, 19 Innovation Walk, Monash University, Melbourne, 3800, Australia.
authors.forename: Quentin A
authors.initials: QA
authors.lastname: Fogg
authors.affiliation: Department of Plastic Surgery, St John's Hospital, Howden Road West, Howden, Livingston, West Lothian, Scotland, EH54 6PP, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Anderson
mesh_terms: D002102:Cadaver; D004210:Dissection; D005260:Female; D000071976:Gracilis Muscle; D006801:Humans; D064827:Myocutaneous Flap; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Anatomy; Gracilis myocutaneous flap; Pedicle length; Perineal reconstruction