Anatomic Variance in Common Vascular Pedicle of the Gracilis and Adductor Longus Muscles: Feasibility of Double Functioning Free Muscle Transplantation with Single Pedicle Anastomosis

ABSTRACT

Fifty thighs from fresh human cadavers were studied to evaluate the feasibility of a double functioning free muscle transfer of the gracilis and adductor longus with single common vascular pedicle anastomosis. Methylene blue intra-arterial injection and loupe-magnified dissection were used to demonstrate three groups of vascular patterns in these two muscles. The common vascular pedicles of 88% of our specimen muscles were long enough for possible anastomosis. Ten percent (type B2) were quite short, making microsurgical procedure difficult. Two percent (type A3) of our specimens were not suitable for single anastomosis. Four percent of our gracilis muscles had two major arterial pedicles that branched from the common pedicle in a Y-shaped configuration. If only one pedicle of this type is harvested during a free gracilis muscle transfer, it may cause inadequate flap perfusion. Four specimens were studied using contrast media angiography to confirm both are Mathes and Nahai type II muscle flaps. In summary, this study typed the common vascular pedicle of our sample of gracilis and adductor longus muscles and confirmed the feasibility of double functioning free muscle transfer of the gracilis and adductor longus with single vascular anastomosis.

KEYWORDS

Adductor longus and gracilis - functioning free muscle transplantation - brachial plexus injury

REFERENCES

• 1 Baliarsing A S, Doi K, Hattori Y. Bilateral elbow flexion reconstruction with functioning free muscle transfer for obstetric brachial plexus palsy.  J Hand Surg [Br]. 2002;  27 484-486
• 2 Chuang D C, Mardini S, Lin S H, Chen H C. Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis.  Plast Reconstr Surg. 2004;  113 126-132
• 3 Doi K, Muramatsu K, Hattori Y et al.. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results.  J Bone Joint Surg Am. 2000;  82 652-666
• 4 Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction.  Plast Reconstr Surg. 1993;  91 872-883
• 5 Giordano P A, Abbes M, Pequignot J P. Gracilis blood supply: anatomical and clinical re-evaluation.  Br J Plast Surg. 1990;  43 266-272
• 6 Hattori Y, Doi K, Abe Y, Ikeda K, Dhawan V. Surgical approach to the vascular pedicle of the gracilis muscle flap.  J Hand Surg [Am]. 2002;  27 534-536
• 7 Mathes S J, Nahai F, Vasconez L O. Myocutaneous free-flap transfer: anatomical and experimental considerations.  Plast Reconstr Surg. 1978;  62 162-166
• 8 Cavadas P C, Sanz-Gimenez-Rico J R, Landin L, Martinez-Soriano F. Segmental gracilis free flap based on secondary pedicles: anatomical study and clinical series.  Plast Reconstr Surg. 2004;  114 684-691
• 9 Lasso J M, Rosado J, Perez Luengo E, Jimenez E, Perez Cano R. Gracilis flap: a variation of the main vascular pedicle.  Plast Reconstr Surg. 2004;  114 597-598
• 10 Taylor G I, Cichowitz A, Ang S G, Seneviratne S, Ashton M. Comparative anatomical study of the gracilis and coracobrachialis muscles: implications for facial reanimation.  Plast Reconstr Surg. 2003;  112 20-30
• 11 Whetzel T P, Lechtman A N. The gracilis myofasciocutaneous flap: vascular anatomy and clinical application.  Plast Reconstr Surg. 1997;  99 1642-1653
• 12 Hasen K V, Gallegos M L, Dumanian G A. Extended approach to the vascular pedicle of the gracilis muscle flap: anatomical and clinical study.  Plast Reconstr Surg. 2003;  111 2203-2208
• 13 Chuang D C, Strauch R J, Wei F C. Technical considerations in two-stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm.  Microsurgery. 1994;  15 338-343
• 14 McCraw J B, Massey F M, Shanklin K D, Horton C E. Vaginal reconstruction with gracilis myocutaneous flaps.  Plast Reconstr Surg. 1976;  58 176-183
• 15 Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction.  Plast Reconstr Surg. 2004;  114 69-73
• 16 Arnez Z M, Pogorelec D, Planinsek F, Ahcan U. Breast reconstruction by the free transverse gracilis (TUG) flap.  Br J Plast Surg. 2004;  57 20-26
• 17 Kappler U A, Constantinescu M A, Buchler U, Vogelin E. Anatomy of the proximal cutaneous perforator vessels of the gracilis muscle.  Br J Plast Surg. 2005;  58 445-448
• 18 Hallock G G. The conjoint medial circumflex femoral perforator and gracilis muscle free flap.  Plast Reconstr Surg. 2004;  113 339-346
• 19 Yousif N J, Matloub H S, Kolachalam R, Grunert B K, Sanger J R. The transverse gracilis musculocutaneous flap.  Ann Plast Surg. 1992;  29 482-490