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Segmental Gracilis Free Flap Based on Secondary Pedicles: Anatomical Study and Clinical Series

The gracilis muscle has been used extensively in reconstructive surgery, based on the proximal dominant pedicle. In the literature, little attention has been paid to the secondary distal pedicles. The distribution of the secondary pedicles of the gracilis muscle was investigated in 20 cadaver thighs. The mean number of secondary pedicles was 2.2 (range, two to three). When two pedicles were present—the most common situation—they were located at a mean distance of 12.4 and 17.5 cm from the knee joint line. The most proximal secondary pedicle was injected with barium sulfate in five specimens, and constant and abundant connections with the main pedicle were noted. A series of seven clinical cases of segmental gracilis free muscle flaps based on a secondary pedicle is reported. The flaps were successfully transferred to reconstruct traumatic defects of limited size, with one case of partial necrosis caused by a technical error. The morbidity of this flap is minimal, the scar is well hidden, the muscle need not be sacrificed, elevation is fast and straightforward under tourniquet control, and the pedicle is sizable. This flap should be considered a viable option when a small, straightforward free flap is needed.