The extended gracilis muscle flap for reconstruction of the lower leg

Holle, J.; Worseg, Artur; Kuzbari, Rafic; Alt, Andreas; Würinger, Elisabeth

doi:10.1016/s0007-1226(95)90044-6

Cited by 38 publications

(24 citation statements)

References 12 publications

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“…Therefore, if the interface between the two is sufficiently stiff, also the supporting function of the intramuscular connective tissue described above will be influenced by the state of the extra-muscular connective tissue and vice versa. For example, removing the epimysium of the human gracilis muscle allows its passive muscle fibers to respond extensively to forces in the cross fiber direction (100% increase in size, Holle et al, 1995). Our present results regarding effects of compartmental fasciotomy (Fig.…”

Section: Interaction Of Extra-and Intramuscular Connective Tissuesupporting

confidence: 52%

Myofascial Force Transmission Causes Interaction between Adjacent Muscles and Connective Tissue: Effects of Blunt Dissection and Compartmental Fasciotomy on Length Force Characteristics of Rat Extensor Digitorum Longus Muscle

Huijing

Baan

2001

Archives of Physiology and Biochemistry

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Muscles within the anterior tibial compartment (extensor digitorum longus: EDL, tibialis anterior: TA, and extensor hallucis longus muscles: EHL) and within the peroneal compartment were excited simultaneously and maximally. The ankle joint was fixed kept at 90°. For EDL length force characteristics were determined. This was performed first with the anterior tibial compartment intact (1), and subsequently after: (2) blunt dissection of the anterior and lateral interface of EDL and TA. (3) Full longitudinal lateral fasciotomy of the anterior tibial compartment. (4) Full removal of TA and EHL muscles.Length-force characteristics were changed significantly by these interventions. Blunt dissection caused a force decrease of approximately 10% at all lengths, i.e., without changing EDL optimum or active slack lengths. This indicates that intermuscular connective tissue mediates significant interactions between adjacent muscles. Indications of its relatively stiff mechanical properties were found both in the physiological part of the present study, as well as the anatomical survey of connective tissue. Full lateral compartmental fasciotomy increased optimum length and decreased active slack length, leading to an increase of length range (by ഠ47%), while decreasing optimal force. As a consequence an increase in force for the lower length range was found. Such changes of length force characteristics are compatible with an increased distribution of fiber mean sarcomere length. On the basis of these results, it is concluded that extramuscular connective tissue has a sufficiently stiff connection to intramuscular connective tissue to be able to play a role in force transmission. Therefore, in addition to intramuscular myofascial force transmission, extramuscular force transmission has to be considered within intact compartments of limbs. A survey of connective tissue structures within the compartment indicated sheet-like neuro-vascular tracts to be major components of extramuscular connective tissue with connections to intramuscular connective tissue stroma.Removal of TA and EHL yielded yet another decrease of force (mean for optimal force ഠ10%). No significant changes of optimum and active slack lengths could be shown in this case. It is concluded that myofascial force transmission should be taken into account when considering muscular function and its coordination, and in clinical decisions regarding fasciotomy and repetitive strain injury. In order to obtain whole body movement, forces need to be transmitted from the muscles to the skeleton to cause acceleration of the limbs. A major location for force transmission is the well-studied myotendinous junction (e.g., Tidball, 1983Tidball, , 1984Tidball, , 1991Tidball, , 1994Tidball & Daniel, 1986;Tidball & Quan, 1992). Such transmission involving transmission of force from one sarcomere to its serial neighbors and eventually onto the myotendinous junction. These junctions are located at the apical ends of muscle fibers, where sarcomeric forces are transmitted onto an...

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Section: Interaction Of Extra-and Intramuscular Connective Tissuesupporting

confidence: 52%

Myofascial Force Transmission Causes Interaction between Adjacent Muscles and Connective Tissue: Effects of Blunt Dissection and Compartmental Fasciotomy on Length Force Characteristics of Rat Extensor Digitorum Longus Muscle

Huijing

Baan

2001

Archives of Physiology and Biochemistry

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“…Usually the muscle is entirely covered with a separate fascia, giving the muscle flap its distinctive appearance. This fascia or perimysium can be removed easily without the aid of any loupes or operating microscope to extend the width of the muscle, as described earlier by Holle et al 5 In our described technique, the muscle is further expanded by the use of visual magnification (such as an operating microscope) by performing intramuscular dissection and cutting all connective tissue. The resulting extra aerial enlargement is significant, with a gain of approximately 3À4 times over the regular gracilis muscle width.…”

Section: Discussionmentioning

confidence: 97%

“…Hence the gracilis muscle is usually chosen for reconstruction of small-to-medium-sized defects. In 1995, Holle et al 5 reported on the possibility of widening the gracilis muscle and employing it for the reconstruction of lower-extremity defects.…”

mentioning

confidence: 99%

Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations

et al. 2004

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The gracilis muscle is one of the most extensively used muscles for free tissue transplantation. Its advantages are low donor-site morbidity with a concealed donor scar, a constant anatomy with large-diameter vessels, and the potential for a neurosensory flap as well as a large skin paddle. However, limitations comprise its limited size, and thus the muscle is limited to small-to-medium-sized defects. We present a novel technique by which the muscle can be enlarged 3-4 times over the regular muscle width. This can be achieved by microscopically aided intramuscular dissection of connective tissue with preservation of the intrinsic vessels of the muscle. With this technique, the field of application of the versatile gracilis muscle in reconstructive surgery can be further expanded.

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“…• Der Muskel kann quer in zwei Transplantate geteilt werden [11] (s. Abbildung 6). • Die durch den Muskel bedeckbare Fläche kann durch Spalten des Perimysiums auf das Dreifache der ursprünglichen Breite vergrößert werden [7,8] (s. Abbildung 7). • Möglichkeit der funktionellen Verwendung [10].…”

Section: Vorteileunclassified