Anatomical study of gracilis muscle: arterial findings enhance graciloplasty

ABSTRACT

To study the neurovascular anatomy of gracilis and to search for different pedicles of suitable size, proximal to dominant pedicle, which could support blood flow to the whole gracilis. Twelve lower limbs obtained from 6 human cadavers were injected with latex/lead oxide mixture into the femoral arteries. The gracilis muscles were dissected, marking the arterial and venous supply, and the nerve entry points. The overall length of the muscle and the length of its tendon were measured. The overall length of musculotendinous unit of gracilis was 42 to 44 cm. The tendon comprised 6 to 8 cm. The main arterial supply to the muscle entered 9-12 cm from the pubic tubercle [diameter, 0.1-0.3 cm]. It arised from the profundafemoris artery and passed between the adductor longus and brevis to enter the upper third of the muscle. The middle pedicle entered the middle of the muscles 19 to 21.5 cm from the pubic tubercle [diameter 0.1 to 0.2cm]. It originated from the femoral artery, passed on the lower border of adductor longus. The distal pedicle was the smallest one, originated from the femoral artery on the lower border of adductor magnus deep to sartorius. It entered the lower part of gracilis. There were additional 2 pedicles found in 2 lower limbs of the same cadaver. One pedicle was proximal to the dominant pedicle and the other was inferior to the middle pedicle. The former was of 0.2 cm in diameter. It originated from the profundafemoris artery in one limb and from the medial femoral circumflex artery in the other limb. Both entered the muscle 3.3 cm or 3.5 cm inferior to the pubic tubercle. The other pedicle arised from the femoral artery. It supplied the sartorius muscle and entered the gracilis below its middle. The motor nerve arised from obturator nerve and entered the muscle in association with the main pedicle. The neurovascular anatomy of gracilis was found to be remarkably consistent from specimen to specimen varying only in the length of muscle and tendon, and the number of minor pedicles supplying it. The existence of proximal pedicle of suitable diameter suggests that it might be able to support the whole gracilis without supply from the main pedicle. This study confirms the suitability of gracilis for segmental functional muscle transfer