Table 1.
Modifications of gracilis flap design in order to increase flap volume.
Figure 1.
Blood supply to the gracilis flap clarifying the nomenclature to be used in this article, and showing the dominant and minor pedicles.
(Adapted from Strauch B, Han-Liang Yu. (2006) Atlas of Microvascular Surgery, 2nd Edition, Thieme).
Figure 2.
Intra-operative relative distal cutaneous ischaemia in a longitudinally designed skin flap.
Table 2.
A summary of the anatomical characteristics of the gracilis vascular pedicles.
Table 3.
A summary of the anatomical characteristics of the gracilis perforator vessels.
Figure 3.
Angiogram of a cadaveric gracilis musculocutaneous flap showing the intramuscular arterial branching pattern of each pedicle.
(Green: Main pedicle, Blue: First minor pedicle, Pink: Second Minor Pedicle, Yellow: Third minor pedicle.).
Table 4.
Cutaneous vascular territory of the gracilis flap based on lead oxide injection into the dominant/main vascular pedicle.
Table 5.
Cutaneous vascular territory of the gracilis flap based on lead oxide injection into the first minor vascular pedicle.
Figure 4.
(A) A ‘screen grab’ image demonstrating the process of quantifying a radiographic injection study of the gracilis muscle and overlying fasciocutaneous tissues.
Image was opened in Image J® and ‘initialized’ in the LVAP ‘Lymphatic Vessel Analysis Protocol’ (LVAP) plug-in. The image was then overlayed with two grids (see methods) to allow systematic quantification of vessel density. Each yellow dot represents a counting point. (B) Graphical representation of the quantified average vessel density in both the muscle and skin specimens, in each one third of the flap.
Figure 5.
(A) A ‘screen grab’ image demonstrating the process of quantifying a radiographic injection study of the gracilis muscle and overlying fasciocutaneous tissues.
Image was opened in Image J® and ‘initialized’ in the LVAP ‘Lymphatic Vessel Analysis Protocol’ (LVAP) plug-in. The image was then overlayed with two grids (see methods) to allow systematic quantification of vessel density. A mouse click is made at the commencement of a vessel as it crosses a grid line and a second click on opposite side of the same vessel. The LVAP program then measures the intervening distance as vessel width for the given vessel, and all widths for the viewing screen (representing one third of the specimen) are averaged and collated. (B) Graphical representation of the quantified average vessel width in both the muscle and skin specimens, in each one third of the flap.
Figure 6.
(A) A ‘screen grab’ image of a radiographic injection study of the gracilis muscle and overlying fasciocutaneous tissue demonstrating the relative perfusion for each one third of the tissues.
Image opened in Image J® and ‘initialized’ in the LVAP ‘Lymphatic Vessel Analysis Protocol’ (LVAP) plug-in. (B) Graphical representation of the relative perfusion for each one third of the tissues of the gracilis muscle and overlying fasciocutaneous tissues.
Figure 7.
An angiogram of a cadaveric gracilis musculocutaneous flap showing a ‘three territory’ flap.
(Green dot: Main pedicle, Purple dot: First minor pedicle, Orange dot: Second Minor Pedicle, Yellow: Third minor pedicle.) The blue line signifies ‘choke zone 1’ and the red line ‘choke zone 2.’
Figure 8.
A cadaveric angiogram showing the gracilis cutaneous ‘two territory’ flap taking the shape of a “T”, positioned posteriorly.
Figure 9.
A computed tomographic angiogram (CTA) of the lower limbs, with coronal maximum intensity projection (MIP) reformat, highlighting the gracilis muscle and its major and minor arterial muscular pedicles.
On the left, one major (green) and one minor (purple) pedicle can be seen and on the right, one major (green) and two minor (purple) pedicles. (Right thigh ‘3 territory’ flap and left ‘two territory’ flap).
Figure 10.
A volume rendered (VR) reformat of a computed tomographic angiogram showing musculo-cutaneous perforators traversing the gracilis muscle to supply the overlying skin.
(Reproduced with permission from: Rozen WM, Chubb D, Grinsell D, Ashton MW. Computed tomographic angiography: clinical applications. Clin Plast Surg. 2011 Apr; 38(2): 229–39.).