Refinement of minimally invasive harvest of gracilis muscle flap without endoscopic assistance.

Minimally invasive surgery without endoscopic assistance for gracilis muscle flap harvest is extensively used at the authors' institution. However, the proximal incision is still visible. The purpose of this study was to place the proximal incision in the groin area, to improve the cosmetic result at the donor site. In the reported series, nine male and three female patients were evaluated, with patient ages ranging from 31 to 75 years. Ten patients had lower extremity reconstruction, one had a forearm defect, and the other, a head and neck defect. The proximal incision was 5 to 6 cm in length in the groin area. The distal incision was 1.5 cm in length around the knee. After adequate exploration and dissection of the major pedicle of the gracilis muscle flap, which was located at 7 to 8 cm below the groin crease under direct vision, a standard long blunt dissector was used to separate the gracilis muscle. The average incision was about 7 cm in length, and the harvesting time was 55 min. All the free muscle transfers were successful and without major complications. The proximal incision was almost invisible after 3 months. Two patients developed partial loss of the skin graft, requiring further skin grafting. Compared with the conventional technique, this method proved to be advantageous in its easier performance, shorter incision, fewer morbidities, and better appearance at the donor site.