The gracilis muscle flap and musculocutaneous flap in the repair of perineal and ischial defects

Abstract

Muscle flaps and musculocutaneous flaps, in recent years, have revolutionised much of plastic surgery. Only certain muscles have a suitable blood supply, however, and one of the first to be recognised was the gracilis muscle. Pickrell et al. (1952) described the successful use of its transposition to correct anal incontinence and later (1956) urinary incontinence. Orticochea (1972) described how to reconstruct a penis with the gracilis and its overlying skin. Pers and Medgyesi (1973) reported a number of uses including repair of a vesico vaginal fistula. Bartholdson and Hulten (1975) transposed the gracilis muscle into 4 cases of large perineal sinuses following proctocolectomy, similar to that described in Case 1. The following 3 cases illustrate how versatile is the gracilis flap with or without its overlying skin. The main blood supply coming through the obturator foramen allows most of the muscle to be transplanted and it can solve some otherwise intractable problems.