Surgery Spotlight: Transverse Upper Gracilis Flap Harvest Technique Using Monopolar Cautery-Surgery Spotlight: Transverse Upper Gracilis Flap Harvest Technique Using Monopolar Cautery

Surgery Spotlight: Transverse Upper Gracilis Flap Harvest Technique Using Monopolar Cautery

Video Transcription

The transverse upper gracilis flap harvest technique using monopolar cautery.  The incisions and markings for the transverse upper gracilis flap start with the transverse superior incision being just inferior to the inguinal crease.  The inferior transverse incision is made approximately 8 cm inferior to this, depending on the laxity of the medial thigh skin.  The most anterior dissection of the flap is limited to being medial to the femoral vessels. The posterior extent of the flap is marked at midline on the back of the buttocks.  Initial skin incisions are made and then inferior undermining is done down the medial thigh and posterior undermining is done down the medial thigh and on to the posterior thigh.  This posterior undermining allows us to capture a large amount of subcutaneous fat for the breast reconstruction.  This dissection continues all the way inferiorly and posteriorly to the semimembranosus and semitendinosus muscles.  It then continues with the elevation from inferior to anterior directly over top of the adductor magnus muscle. Again, this is done using electrocautery on a coag setting.  The anterior dissection is done starting again medial to the femoral vessels and staying superficial to the saphenous vein.  Once this is done, retraction of the adductor longus muscle allows for easy dissection of the loose areolar tissue on top of the muscle,  continued retraction and cauterization of the small fibrous tissue will allow for easy visualization of the pedicle and especially the branch on the medial side of the adductor longus muscle going into the adductor longus muscle.  The pedicle to the gracilis muscle and the medial branch to the adductor longus muscle are visualized here.  The gracilis muscle is cut inferiorly, just distal to the inferior edge of the flap. The muscle, its loose areolar tissue, and the overlying fat and skin are dissected from  inferior to superior. Continued electrocautory dissection is done, elevating the muscle, subcutaneous fat and skin off the adductor magnus muscle.  This is done from an inferior posterior direction to an anterior superior direction. The superior part of the gracilis muscle is now transected.  After this is done, lateral retraction of the adductor longus muscle and coagulation  of small muscle branches allows for easy visualization of these two predictably present medial branches going into the adductor longus. Each of these are clipped and cut.  This allows for a safe and easy dissection of the vascular pedicle underneath the adductor longus muscle.  Once this is completed, the adductor longus is retracted medially, and again, the loose areolar tissue over top of the muscle is dissected out.  On the lateral side of the adductor longus muscle, there also exists a perforator going into the muscle. Again, muscle fibers are split. This perforator is clipped and cut.  This facilitates easy visualization of the vascular pedicle going into the profunda vessels.

Video Summary

The video describes the technique for harvesting a transverse upper gracilis flap using monopolar cautery, primarily for breast reconstruction. Incisions are made below the inguinal crease, and dissection extends from medial to the femoral vessels to the midline of the buttocks. The procedure involves careful dissection above the adductor magnus muscle and around the femoral vessels while preserving the saphenous vein. Key steps include exposing and clipping pedicles to the gracilis muscle and managing tissue around the adductor longus muscle. The technique allows for efficient harvest of muscle and subcutaneous fat for reconstructive use.

Asset Caption

In this video, Ed Buchel, MD demonstrates the transverse upper gracilis flap harvest technique using monpoloar cautery for breast reconstruction. The demonstration includes markings, incisions, and the harvest procedure.

Surgeon Ed Buchel, MD This product is not certified for CME.

Keywords

Surgical Videos

surgery spotlight

Breast

Ed Buchel MD

TUG; Memben

transverse upper gracilis flap

breast reconstruction

monopolar cautery

femoral vessels

adductor magnus muscle