Further Experience with the Medial Circumflex Femoral_GRACILIS Perforator Free Flap

The microsurgical transfer of the medial groin skin territory previously required this to be part of a transverse-oriented gracilis musculocutaneous free flap. As the concept of muscle perforator flaps has evolved, avoidance of muscle bulk and/or retention of muscle function here is also possible with the careful intramuscular dissection of the gracilis musculocutaneous perforators back to the usual medial circumflex femoral source vessel. This so-called medial circumflex femoral_GRACILIS [MCF_GRACILIS] perforator free flap has been successfully used seven times in six patients with minimal complications.

The MCF_GRACILIS muscle perforator flap may well represent the ideal skin flap: no muscle function is sacrificed; a reliable skin territory of large size is available; the dominant vascular pedicle is consistent in location; the flap may be harvested with the patient in a supine position; a combined conjoint flap including the gracilis muscle is optional; closure of the donor site leaves a medial groin scar that can be readily concealed; and flap dissection in this region is already very familiar to most microsurgeons.

KEYWORDS

Medial circumflex femoral - gracilis - muscle perforator flap

REFERENCES

• 1 Orticochea M. The musculo-cutaneous flap method: an immediate and heroic substitute for the method of delay.  Br J Plast Surg. 1972;  25 106-110
• 2 McCraw J B, Dibbell D G, Carraway H J. Clinical definition of independent myocutaneous vascular territories.  Plast Reconstr Surg. 1977;  60 341-352
• 3 Heckler F R. Gracilis myocutaneous and muscle flaps.  Clin Plast Surg. 1980;  7 27-44
• 4 Yousif N J, Matloub H S, Kolachalam R et al.. The transverse gracilis musculocutaneous flap.  Ann Plast Surg. 1992;  29 482-490
• 5 Whetzel T P, Lechtman A N. The gracilis myofasciocutaneous flap: vascular anatomy and clinical application.  Plast Reconstr Surg. 1997;  99 1642-1652
• 6 Har-Shai Y, Hirshowitz B, Marcovich A et al.. Blood supply and innervation of the supermedial thigh flap employed in one-stage reconstruction of the scrotum and vulva-an anatomical study.  Ann Plast Surg. 1984;  13 504-510
• 7 Wang T S, Whetzel T, Mathes S J, Vasconez L O. A fasciocutaneous flap for vaginal and perineal reconstruction.  Plast Reconstr Surg. 1987;  80 95-102
• 8 Wechselberger T, Schoeller T, Bauer T et al.. Surgical technique and clinical application of the transverse gracilis myocutaneous free flap.  Br J Plast Surg. 2001;  54 423-427
• 9 Hallock G G. The gracilis (medial circumflex femoral) perforator flap-a medial groin free flap?.  Ann Plast Surg. 2003;  51 623-626
• 10 Hallock G G. The conjoint medial circumflex femoral perforator and gracilis muscle free flap.  Plast Reconstr Surg. 2004;  113 339-346
• 11 Geddes C R, Morris S F, Neligan P C. Perforator flaps: evolution, classification, and applications.  Ann Plast Surg. 2003;  50 90-99
• 12 Holle J, Worseg A, Kuzbari R et al.. The extended gracilis muscle flap for reconstruction of the lower leg.  Br J Plast Surg. 1995;  48 353-359
• 13 Morris S F, Yang D. Gracilis muscle: arterial and neural basis for subdivision.  Ann Plast Surg. 1999;  42 630-633
• 14 Wei F C, Jain V, Suominen S, Chen H C. Confusion among perforator flaps: what is a true perforator flap?.  Plast Reconstr Surg. 2001;  107 874-876
• 15 Giordano P A, Abbes M, Pequignot J P. Gracilis blood supply: anatomical and clinical re-evaluation.  Br J Plast Surg. 1990;  43 266-272
• 16 Hallock G G. Simplified nomenclature for compound flaps.  Plast Reconstr Surg. 2000;  105 1465-1470
• 17 Watterson P A, Taylor G I, Crock J G. The venous territories of muscles: anatomical study and clinical implications.  Br J Plast Surg. 1988;  41 569-585
• 18 Gosain A, Chang N, Mathes S et al.. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps.  Plast Reconstr Surg. 1990;  86 1152-1162
• 19 Anthony J P, Mathes S J. The groin flaps. In Hallock GG Fasciocutaneous Flaps Blackwell Scientific. Boston; 1992: 89-95
• 20 Cavadas P C, Teran-Saavedar P P. Combined latissimus dorsi-thoracodorsal artery perforator free flap: the “razor flap”.  J Reconstr Microsurg. 2002;  18 29-31
• 21 Blondeel P N, Arnstein M, Verstraete K et al.. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 1295-1299
• 22 Kimura N. A microdissected thin tensor fasciae latae perforator flap.  Plast Reconstr Surg. 2002;  109 69-77
• 23 Wei F C, Jain V, Celik N et al.. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps.  Plast Reconstr Surg. 2002;  109 2219-2226