Gracilis flap: muscle or myocutaneous interposi4on for pelviperineal reconstruc4on
Seance of wednesday 23 september 2026 (L'Académie reçoit l'Association Française d'Urologie "AFU" : Les lambeaux en urologie reconstructrice)
DOI number : 10.26299/4a6m-0518/emem.2026.39.03
Abstract
The gracilis muscle flap is a gold-standard solu4on for complex pelvi-
perineal reconstruc4ons. Its use was first described by Ryan et al. in 1979
for the repair of a retro-rectal fistula.
Due to its anatomical proximity, this muscle—located on the inner thigh—
is most commonly used as a local pedicled flap. Its dominant vascular
pedicle, arising from the deep femoral artery, serves as a pivot point,
allowing for tension-free rota4on toward the pelvis.
This technique provides well-vascularized 4ssue to fill the perineal dead
space and separates rectal and urethral suture lines, par4cularly when
4ssues have undergone prior radia4on or scarring.
Furthermore, the donor site is closed primarily, resul4ng in minimal
func4onal and aesthe4c sequelae.
Its use is not limited to the male pelvis; it is also employed in oncological
cases involving women (such as radionecrosis) and in the treatment of
rectovaginal fistulas.
Consequently, surgeons performing pelvi-perineal reconstruc4on should
be proficient in this technique.
perineal reconstruc4ons. Its use was first described by Ryan et al. in 1979
for the repair of a retro-rectal fistula.
Due to its anatomical proximity, this muscle—located on the inner thigh—
is most commonly used as a local pedicled flap. Its dominant vascular
pedicle, arising from the deep femoral artery, serves as a pivot point,
allowing for tension-free rota4on toward the pelvis.
This technique provides well-vascularized 4ssue to fill the perineal dead
space and separates rectal and urethral suture lines, par4cularly when
4ssues have undergone prior radia4on or scarring.
Furthermore, the donor site is closed primarily, resul4ng in minimal
func4onal and aesthe4c sequelae.
Its use is not limited to the male pelvis; it is also employed in oncological
cases involving women (such as radionecrosis) and in the treatment of
rectovaginal fistulas.
Consequently, surgeons performing pelvi-perineal reconstruc4on should
be proficient in this technique.