Anatomic Variance in Common Vascular Pedicle of the Gracilis and Adductor Longus Muscles: Feasibility of Double Functioning Free Muscle Transplantation with Single Pedicle Anastomosis

Abstract

Fifty thighs from fresh human cadavers were studied to evaluate the feasibility of a double functioning free muscle transfer of the gracilis and adductor longus with single common vascular pedicle anastomosis. Methylene blue intra-arterial injection and loupe-magnified dissection were used to demonstrate three groups of vascular patterns in these two muscles. The common vascular pedicles of 88% of our specimen muscles were long enough for possible anastomosis. Ten percent (type B2) were quite short, making microsurgical procedure difficult. Two percent (type A3) of our specimens were not suitable for single anastomosis. Four percent of our gracilis muscles had two major arterial pedicles that branched from the common pedicle in a Y-shaped configuration. If only one pedicle of this type is harvested during a free gracilis muscle transfer, it may cause inadequate flap perfusion. Four specimens were studied using contrast media angiography to confirm both are Mathes and Nahai type II muscle flaps. In summary, this study typed the common vascular pedicle of our sample of gracilis and adductor longus muscles and confirmed the feasibility of double functioning free muscle transfer of the gracilis and adductor longus with single vascular anastomosis.