Author:
Gulyaev D.A.,Begjanyan A.S.,Kaurova T.A.,Belov I.Yu.,Kurnosov I.A.
Abstract
Autotransplantation of a free flap of the gracilis muscle is currently actively used in reconstructive surgery for persistent prosoplegia, injuries of the brachial plexus, for plastic closure of defects in the upper lip, and in the treatment of pelvic sepsis. This study provides important information about the anatomical features of the gracilis muscle and its neurovascular bundle, which are highly variable. The study of the anatomical and topographic features of this fine thigh muscle was carried out on a sectional study of 25 corpses of both sexes, 50 lower limbs. The present study demonstrates that the median value of the total length of m. Gracilis, the length of its muscular part, as well as the length of the tendon were 452.25 (439.7; 462.0); 225.3(208.1;239.0); 230.5 (213.0; 244.4) mm, respectively. The number of vascular pedicles included in m. Gracilis, ranged from 1 to 5. In 86% of the cases, the deep femoral artery formed the dominant vascular pedicle, and in 14% of cases, it was the medial circumflex artery. Small secondary vascular pedicles originated from the descending genicular artery or the anterior branch of the obturator arter: from the basin of the internal iliac artery. The length of the main feeding artery varied from 76 to 134 mm, the median value was 100.5(90;110) mm, and its diameter ranged from 1.4 to 2.1 mm (M = 1.9(1.8;2, 0) mm. The innervation of the fine muscle of the thigh was carried out by the anterior branch of the obturator nerve, which in 82% of the cases was represented by a single trunk; less often a loose type of structure was observed. The proper nerve was located at a distance of 108.5 (96; 117) mm from the origin of the muscle; its diameter was 2.1 (1.9; 2.2) mm. Knowledge of the topographic and anatomical relationships of the neurovascular bundle with the surrounding formations, variants of its individual anatomical variability are the key to successful reconstructive surgery.
Reference21 articles.
1. Standring S. Pelvic girdle and lower limb: overview and surface anatomy In: Gray’s anatomy: The Anatomical Basis of Clinical Practice, 41th ed, Elsevier Churchill Livingstone, Edinburgh, London, New York, Oxford, Philadelphia, St Louis, Sydney,Toronto.2016;1337-1375.
2. Shatari T, Niimi M, Fuiita M, Kodaira S. Vascular Anatomy of Gracilis muscle, arterial findings to enhance Graciloplasty. Surg. Radiol. Anat. 2000;22(1):21-4.
3. Huemer GH, Dunst KM, Maurer H, Ninkovic M. Area enlargement of gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations. Microsurgery. 2004; 24(5):369-73.
4. Ortiz H, Armendariz P, DeMiguel M, Solana A, Alos R, Roig JV. Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence. Int J Colorectal Dis. 2003;18:349-54.
5. Vigato E, et al. The clinical role of the gracilis muscle: an example of multidisciplinary collaboration. Pelviperineology. 2007; 26:149-51.