he transverse myocutaneous gracilis flap was described for breast reconstruction in 1992 following cadaveric perfusion studies suggesting that transverse orientation of skin paddles lowered the risk of distal skin necrosis compared to vertical orientation. 1 Despite the local popularity of the transverse upper gracilis flap, previously published high donor-site complication rates and a perception of poor patient satisfaction limit its use. [2][3][4][5][6][7][8] Over the past three decades, techniques have developed with modifications likely to decrease donor-site morbidity and improve patient satisfaction. 2,3,9 Transverse upper gracilis flap breast reconstruction accounts for 8 percent of autologous mastectomy defect reconstruction at the reporting institution, making it the most used donor site after the abdomen. The deep inferior epigastric
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