The gracilis muscle and its use in clinical reconstruction: An anatomical, embryological, and radiological study

Abstract

The gracilis muscle is used widely in reconstructive surgery, as a pedicled or as a free microsurgical flap, for soft tissue coverage or as a functioning muscle transfer. Many studies, based on cadaver dissections, have focused on the vascular anatomy of the gracilis muscle and provided different data about the number, origin, and caliber of its vascular pedicles. Computed tomographic (CT) angiography of both thighs of 40 patients (35 males and 5 females, mean age: 63 years) have been analyzed to provide a detailed anatomical description of the arterial supply of the gracilis muscle. The gracilis muscle had a mean length of 41 +/- 2.1 cm. The principal pedicle enters the gracilis muscle at a mean distance (+/-SD) of 10 +/- 1 cm from the ischiopubic attachment of the muscle. Its caliber shows a mean value of 2.5 +/- 0.5 mm, and it is statistically larger when originating directly from the deep femoral artery (45%) than from its muscular branch supplying the adductors, i.e., the "artery to the adductors" (46%) (P < 0.01). A significant correlation between the caliber of the artery of the main pedicle and the volume of the gracilis muscle was found (P < 0.01). The mean number of distal accessory pedicles is 1.8 (range, 1-4,) and the artery of the first of these pedicles shows a mean caliber of 2.0 mm. There is no correlation between either the number or the caliber of the artery of the accessory pedicles and the volume of the gracilis muscle. CT angiography, providing detailed images of the muscular and vascular structures of the thigh of each patient, could be a useful preoperative study for the reconstructive surgeon. It would allow a personalized planning of a gracilis flap, reducing the risk of iatrogenic damage.

Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

“…Surgery necessarily alters the vascular architecture of tissues, and it has been shown that local vascular morphology is universally altered, with the source vessels supplying cutaneous tissues often markedly different to that expected. In addition, maintenance of the caliber of vessels within the flap was highlighted in the current study, with the absence of sympathetic tone after flap transfer an established phenomenon [5,14]. This is one of the many anatomic and physiologic changes that occur following flap transfer or any surgical intervention.…”

AN ANATOMICAL STUDY OF GRACILIS MUSCLE & ITS ROLE IN CLINICAL RECONSTRUCTION SURGERIES

“…Length of muscle in both male &femal was more compared to others studies, muscle belly in male is more when compared to theirs studies &less in females compared tohurbanetal [9], total tendon length in both male & femal is more compared to others study, distal tendon length in both male & femal is more compared to others study, pedicle length from origin was less compared to vigatoetal [5], morrisetal [10], machii vetal [13], rajeshwarietal [14], lainetal [2] studies and more compared to Hurban etal 9 , Hussy et al [11], Dorothee etal [15]. Gracilis muscle derives its vascular supply from a wide range of arteries.…”

Body parts removed during surgery: A useful training source

“…Within surgical departments, the need for professionals in human gross anatomy is uncontested (Fasel et al, 2005). In our experience, anatomic and clinical research examines anatomical structures from new perspectives (Macchi et al, 2007b(Macchi et al, ,c, 2008 and can lead to improved surgical practice (Tiengo et al, 2004(Tiengo et al, , 2007Macchi et al, 2005). In our project, the continuity of the diagnostic and therapeutic phases was achieved by the active involvement of residents in the steps involved in donation of body parts.…”