Use of a Bilobed Gracilis Myocutaneous Flap in Perineal and Genital Reconstruction

作者：Vyas Raj M^*; Pomahac Bohdan

来源：Annals of Plastic Surgery, 2010, 65(2): 225-227.

DOI：10.1097/SAP.0b013e3181c9c434

• reconstructive surgery
• bilobed flap
• gracilis myocutaneous flap
• perineal reconstruction
• vulvovaginal reconstruction
• rectal reconstruction
• fistula repair
• angiosome

The gracilis myocutaneous flap has limited functional donor site morbidity and effectively contours genitoperineal reconstructions. When harvested using a traditional vertical skin paddle, distal-tip necrosis (secondary to inconsistent perforator anatomy) is a well-documented complication. Orienting the skin paddle transversely provides a reliable alternative with a shorter rotational arc but results in a more conspicuous deformity and smaller skin paddle when primary closure is desired. On the basis of recent anatomic studies, we designed a pedicled gracilis myocutaneous flap with a bilobed cutaneous paddle to maximally incorporate both the transverse and longitudinal dimensions of the flap's nearly circular angiosome. The bilobed design allows harvest of a larger transverse skin flap (with a shorter arc of rotation) while a shorter, more dependable vertical skin flap is inset into the transverse flap donor site (rather than inside the critical wound bed). Herein, we detail our surgical technique and provide 2 illustrative case examples.

• 出版日期2010-8