Gracilis Free Functioning Muscle Transfer for Reanimation

Description

In this instructional video from the Hospital for Special Surgery, the surgical process for harvesting a gracilis muscle transfer is presented by Dr Duretti Fufa. The goal of the surgery is to utilize this free functioning myocutaneous flap to reanimate the elbow. The video breaks down the essential aspects of the gracilis muscle, discussing its anatomy, including the blood supply from the medial femoral circumflex and its innervation by branches of the obturator nerve. The advantages of harvesting this flap are highlighted, such as its reliability and minimal donor site morbidity, while also addressing the limitations of the small caliber vessels and the need for careful handling of the skin paddle to ensure vascular integrity.



The surgical technique is detailed, beginning with the identification of the gracilis muscle positioned posteriorly to the adductor longus muscle through specific surface markings. A counter incision at the knee is made to facilitate the identification of the gracilis tendon. The harvesting technique emphasizes the preservation of the investing fascia and the careful isolation of both the vascular pedicle and the nerve branch to prevent injury, which is crucial during the procedure.



Throughout the dissection, key concepts like maintaining hemostasis, identifying the correct vascular and nerve structures, and ensuring the maximum pedicle length for adequate blood supply are emphasized. Postoperative care protocols, including patient monitoring and splinting recommendations for elbow positioning, are provided to outline the anticipated recovery processes after the gracilis muscle transfer.

Specialties