Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations.

The gracilis muscle is one of the most extensively used muscles for free tissue transplantation. Its advantages are low donor-site morbidity with a concealed donor scar, a constant anatomy with large-diameter vessels, and the potential for a neurosensory flap as well as a large skin paddle. However, limitations comprise its limited size, and thus the muscle is limited to small-to-medium-sized defects. We present a novel technique by which the muscle can be enlarged 3-4 times over the regular muscle width. This can be achieved by microscopically aided intramuscular dissection of connective tissue with preservation of the intrinsic vessels of the muscle. With this technique, the field of application of the versatile gracilis muscle in reconstructive surgery can be further expanded.