Anatomy Of Transverse Upper Gracilis(TUG) Flap Supplied By Branch Of The Profunda Femoris Artery And The Application In The Field Of Breast Reconstruction

Objective To provide anatomic basis for the clinical application of the transverse upper gracilis flap supplied by profunda femoris artery in breast reconstruction. Also to discuss the possibility of making a perforator flap and being applied to breast reconstruction.Method In8adult cadaver lower extremities injected with red latex through Popliteal Artery, we observed the presence rate, route, outer diameter and pedicle length of the branch of the profunda femoris artery. The accompanying vein, great saphenous vein and nerve were also examined. Then, the clinical way was simulated to design and obtain the flap on the body.Result75%of artery supplied TUG flap were from profunda femoris artery, and25%from medial femoral circumflex artery. The pedicle entered the gracilis (13.21±1.03) cm below the start of gracilis with outer diameter being (1.35±0.30) mm, giving off2-3cutaneous branches alongside, and all the cutaneous branches were musculocutaneous perforators. The average outer diameter of The dominant perforator was (1.59±0.27) mm. The pedicle length was (74.14±9.42) mm with outer diameter being (2.77±0.54) mm, and (2.83±0.63) mm for the accompanying vein. In our study, the presence rate of the great saphenous vein branches was87.5%, only one specimen had no branch, all the others had one with the outer diameter of (2.60±0.64) mm. The diameter of obturator nerve was (1.85±0.53) mm.Conclusion①The profunda femoris artery branch had a high presence rate in upper1/3of gracilis, thus the transverse upper gracilis flap is a reliable donor site for breast reconstruction.②Tere were relatively constant great saphenous vein branch, which could be reserved for better venous return.③It was possible to make a perforator flap in some cases to avoid unnecessary muscle damage.④The feasibility of the transverse upper gracilis flap supplied by branch of the profunda femoris artery was demonstrated by the modeling operation on the cadaver. The operation time is shorter because of the clear vascular pedicle hierarchy.⑤The incision was subterranean and more acceptable by patients.