Authors: Emma Tubæk Nielsen, MD., Caroline Lilja, MD., and Magnus Balslev Avnstorp, MD.

Introduction

This chapter introduces the gracilis flap, its biomechanical properties, applications, and preoperative considerations, as well as a step-by-step walkthrough of the surgical procedure of raising the flap.

Definition

The gracilis flap is often used as a muscular free flap, and harvesting of a larger skin island along with the muscle is possible. It is mostly used in head and reck reconstructions including dynamic restoration of the midface following facial paralysis.^1,4

The flap may also be used as a perforator flap for reconstruction in the peri-anal and vaginal area, i.e. larger perianal fistulas or restoration of anogenital sphincter function.

Finally the flap may be used as a TMG (Trans muscular gracillis) flap flap with skin paddle for breast reconstruction with smaller volumes.

Nomenclature

The gracilis flap has been utilized as a local pedicled flap for decades, particularly for restoration of anogenital sphincter function.¹ It was used as a free flap for facial rehabilitation for the first time in 1976 by Harii K.²