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The Transverse Musculocutaneous Gracilis Flap for Breast Reconstruction: Guidelines for Flap and Patient Selection

Schoeller, Thomas M.D., M.Sc.; Huemer, Georg M. M.D.; Wechselberger, Gottfried M.D., M.Sc.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 29-38
doi: 10.1097/PRS.0b013e318177436c
Breast: Original Articles

Background: The transverse musculocutaneous gracilis (TMG) flap has received little attention in the literature as a valuable alternative source of donor tissue in the setting of breast reconstruction. The authors give an in-depth review of their experience with breast reconstruction using the TMG flap.

Methods: A retrospective review of 111 patients treated with a TMG flap for breast reconstruction in an immediate or a delayed setting between August of 2002 and July of 2007 was undertaken. Of these, 26 patients underwent bilateral reconstruction and 68 underwent unilateral reconstruction, and 17 patients underwent reconstruction unilaterally with a double TMG flap. Patient age ranged between 24 and 65 years (mean, 37 years).

Results: Twelve patients had to be taken back to the operating room because of flap-related problems and nine patients underwent successful revision microsurgically, resulting in three complete flap losses in a series of 111 patients with 154 transplanted TMG flaps. Partial flap loss was encountered in two patients, whereas fat tissue necrosis was managed conservatively in six patients. Donor-site morbidity was an advantage of this flap, with a concealed scar and minimal contour irregularities of the thigh, even in unilateral harvest. Complications included delayed wound healing (n = 10), hematoma (n = 5), and transient sensory deficit over the posterior thigh (n = 49).

Conclusions: The TMG flap is more than an alternative to the deep inferior epigastric perforator (DIEP) flap in microsurgical breast reconstruction in selected patients. In certain indications, such as bilateral reconstructions, it possibly surpasses the DIEP flap because of a better concealed donor scar and easier harvest.

Innsbruck, Austria

From the Department of Plastic and Reconstructive Surgery, Medical University Innsbruck.

Received for publication August 6, 2007; accepted November 18, 2007.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Thomas Schoeller, M.D., M.Sc., Department of Plastic and Reconstructive Surgery, Medical University Innsbruck, Anichstraβe 35, 6020 Innsbruck, Austria,

©2008American Society of Plastic Surgeons