(1)
Yotsuya Medical Cube, Chiyoda-ku, Tokyo, Japan
Basic Principles
Free muscle graft is indicated for reconstruction in cases where the muscle has been lost or has become paralyzed in the forearm or face. However, if tendon transfer can be conducted for reconstructing the function of the arm, a free muscle graft is not the first option.
Muscles consist of pennate muscles that have a large contractile force but short contraction length (for example rectus femoris muscle) and fusiform muscles that have long muscle fibers and a long sliding distance (gracilis muscle, pectoralis major muscle, latissimus dorsi etc.). Of these two, fusiform muscles with the long sliding distance are suitable for reconstruction of the flexor muscles of the forearm, and the gracilis muscle which possesses tendon characteristics is the first option.
Selectable Flaps and Surgical Procedures
Gracilis muscleLatissimus dorsi muscleSerratus anterior muscleThe difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.
25.1 Free Vascularized Gracilis Muscle Graft (Level of Difficulty: 4)
Information
Vascular pedicle Medial circumflex femoral artery
Nerve Anterior branch of obturator nerve (It runs 2 cm forward to the vascular pedicle)
Advantage As long as the muscle can be identified, detachment is simple, and the vascular pedicle is sufficiently thick
Disadvantage The blood flow to the skin above the muscle is supplied by the muscle, however the distal 1/3 is supplied by the sartorius muscle and the border is not distinct
Caution Where a musculocutaneous flap is desired, design the flap with the hip joint in the fully open extended position. If designed with the hip joint or knee joint in the bent position, the design will be forward of the desired area, which can lead to necrosis of the skin area, so care is required.
