Transversely Dividing Gracilis Muscle Free Flap for the Simultaneous Reconstruction of Two Anatomically Distant Defects

Lee, Dong Chul; Hwang, Ho Bum; Yang, Jae Won; Rho, Si Young; Ki, Sai Hwi; Kim, Jin Soo

Abstract

Free muscle flap for the simultaneous coverage of two anatomically distant sites has previously entailed the harvest of tissue from separate donor areas, Although it may be possible to achieve this goal with a variety of available donor site, the transfer of a single donor muscle to two different sites has been considered. The gracilis muscle is commonly usef by reconstructive surgeon in a variety of application as pedicled muscle or musculocutaneous flap and as a free tissue transfer for soft tissue coverage or a functioning muscle transfer. The gracilis muscle is classified as having a type II blood supply that anatomy is reliable. The main arterial supply to the gracilis muscle is a branch of the profunda femoris, which enters the muscle 10+/-1cm from its attachment to the pubis on its deep(lateral) surface. The distal portion of muscle between the main arterial pedicle and musculotendinous junction is supplied by one to three small arterial branches of the superficial femoral artery. The first minor pedicle located approximately 20 cm from the pubis. In 1990 Tadeusz reported the successful treatment of patient with bilateral calcaneal fractures and posttraumatic osteomyelitis using a longitudinal single split free gracilis muscle transfer. In 2001 We performed a transversely dividing gracilis muscle free flap in the patient with two soft tissue defects and osteomyelitis in anterior tibial region and foot.