Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 18:
Vascularized Muscle Transplantation and Gracilis Muscle Transplantation
  A 68-year-old diabetic developed a nonhealing left instep ulcer that progressed to osteomyelitis.

FIG. 18-21. After thorough debridement, a large cavity with exposed bone remained.

FIG. 18-22. The isolated gracilis flap and recipient wound are shown.

FIG. 18-23. The proximal pedicle was anastomosed end-to-side to the anterior tibial vessel.

FIG. 18-24. The entire muscle was skin-grafted.

FIG. 18-25. Follow-up at 18 months shows a healed wound without breakdown: A mirror ulcer has developed on the opposite foot, and was treated in a similar fashion.


The gracilis muscle was again used to close a chronic draining wound over the fourth metatarsal of a diabetic.

FIG. 18-26. Appearance of ulcer.

FIG. 18-27. Gracilis muscle is draped over widely debrided wound, vessels repaired to the anterior tibials.

FIG. 18-28. At 3 years, the patient is ambulatory in normal shoes.



Industrial injury to the lateral anterior compartment of the right leg and foot produced partial loss of the extensor muscles. The gracilis was used as a dynamic transplant and also replaced the unstable scar on the lower third of the leg and lateral malleolar region.

FIG. 18-29. The extent of the unstable scar and muscle defect.

FIG. 18-30. Gracilis muscle transplant in place with proximal anastomoses of the vessels to the anterior tibial vessels and the motor branch of the gracilis to a motor branch of the anterior tibial nerve.

FIG. 18-31. The well-healed gracilis muscle in place, with the foot in neutral position.

FIG. 18-32. Contraction of the gracilis gives increased dorsiflexion of the foot.


A 16-year-old girl suffered a trigeminal and facial nerve injury during removal of a cerebellar tumor.

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