Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Laurenz Weitgasser,Gottfried Wechselberger,Elisabeth Russe,Thomas Schoeller,Maximilian Mahrhofer,Karl Schwaiger,Kathrin Bachleitner

doi:10.3390/jcm10163629

Abstract

Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

Highlights

Yousif et al first published the detailed anatomy of the transverse myocutaneous gracilis (TMG) flap and clinical applications in the Annals of Plastic Surgery Journal in December 1991 [1]
The senior authors (Gottfried Wechselberger and Thomas Schoeller) who were among the forerunners in TMG flap breast reconstruction back in the late 1990s and published numerous important manuscripts about its use share their knowledge and were asked to critically judge and discuss the current role of the TMG flap compared to its alternatives
Three hundred patients who had a unilateral breast reconstruction with a TMG flap at the senior authors institutions between September 2010 and October 2020 were reviewed in a retrospective double center cohort study

Summary

Introduction

Yousif et al first published the detailed anatomy of the transverse myocutaneous gracilis (TMG) flap and clinical applications in the Annals of Plastic Surgery Journal in December 1991 [1]. Due to problems of partial skin paddle necrosis with the gracilis myocutaneous flap it did not receive as much attention in the following years [2,3]. It was not until a series of publications by the senior authors of this study, Gottfried. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction.

Methods

Results

Conclusion