Use of a bilobed gracilis myocutaneous flap in perineal and genital reconstruction

Ann Plast Surg. 2010 Aug;65(2):225-7. doi: 10.1097/SAP.0b013e3181c9c434.


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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Female
  • Humans
  • Middle Aged
  • Muscle, Skeletal / transplantation*
  • Perineum / surgery*
  • Reconstructive Surgical Procedures / methods*
  • Skin Transplantation / methods*
  • Surgical Flaps*
  • Thigh
  • Vagina / surgery*