Harvest of an Entire Gracilis Muscle and Tendon for Use in Functional Muscle Transfer: A Novel Technique

The use of the free functioning, innervated gracilis muscle has evolved to become an invaluable tool in the restoration of elbow flexion and prehension in patients undergoing reconstruction following brachial plexus injuries. Although there are many different methods of the gracilis muscle harvest, most if not all harvest methods begin proximally. The purpose of this article is to describe a novel distal harvest technique of the gracilis myocutaneous flap for brachial plexus patients requiring restoration of elbow or finger flexion. A harvest method commencing with a distal dissection either at the distal insertion of the gracilis at the pes anserine or at the distal medial thigh at the myotendinous junction will be described. The advantage of this novel method is to ensure that the entire gracilis muscle and its tendon are harvested to maximize the length of tendon that can be secured by a Pulvertaft weave into the biceps tendon or the finger flexors for elbow flexion and finger flexion respectively.