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Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al. | ||
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| The gracilis muscle may be used to replace areas of ulceration caused by irradiation or areas with nonhealing wounds secondary to systemic conditions as diabetes mellitus. In these patients, the new blood supply brought to the region by the muscle depends on major regional vessels that are not as subject to the vasculitic effects of irradiation or diabetes as are the smaller vessels in the area. The gracilis muscle has also been used successfully to cover ulcers secondary to deep venous disease; however, because muscle transplantation does not treat the primary pathophysiology of the condition, the results have not been as uniformly successful as in patients with the other problems that have been discussed.
The gracilis muscle has been used as a functional muscle transplant for post-traumatic functional or anatomic loss of the volar forearm musculature and Volkmann's ischemic contracture.6-9 The muscle may also be successfully transplanted to reanimate the paralyzed face; however, its excessive bulk and mass action may be disadvantageous.10 The serratus anterior muscle is our first choice for transplantation in patients with facial paralysis. Motor innervation for either muscle is provided through a previously placed, crossfacial nerve graft through which motor axons have been parasitized from a sampling of facial nerve branches on the contralateral intact side. |
The gracilis muscle may be used for contour restoration in patients with defects of appropriate size in the head and neck region. The unpredictability of the amount of muscle atrophy, however, makes the gracilis a potentially poor choice for this application. TECHNICAL CONSIDERATIONS Postoperative angiography to delineate the vasculature in the recipient area is desirable. In the lower extremity, the status of the anterior tibial, posterior tibial, and peroneal arteries is determined. It is not uncommon for one or more of these vessels to have been damaged in the primary injury. Preoperative knowledge of this information is critical in planning the muscle transplant, choosing which vessel is appropriate as the recipient artery, and deciding whether end-to-end or end-to-side anastomosis will be performed. Similarly, in the upper extremity, the status of the radial and ulnar arteries should be evaluated. In the head and neck region, selective external carotid angiography provides the proper information about the recipient vasculature. |
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