The gracilis muscle is commonly used as a flap in microsurgery. According to the classification of Mathes and Nahai, it presents a type II blood supply, allowing it to be transferred on its artery derived from the medial circumflex femoral artery.
Gracilis muscle is widely used in reconstructive surgery (graciloplasty), either as a pedicled flap or as a free microsurgical flap. Both pedicled and free flaps can be muscular or musculocutaneos aka "composite flaps". As a pedicled flap, gracilis muscle can be used in perineal and vaginal reconstruction, after oncological surgery, in the treatment of recurrent anovaginal and rectovaginal fistulas as well in the coverage of the neurovascular bundle after vascular surgery.
As a functioning pedicled flap, the gracilis muscle can be transferred for the treatment of anal incontinence. This technique called graciloplasty was described in the 1950s by Pickrell and was revolutionized in the late 1980s by the introduction of chronic muscle electro-stimulation. The gracilis microsurgical free flap is commonly used in the reconstruction of upper and lower limbs, in breast reconstruction and – as a free functioning flap – to restore forearm function or in dynamic reconstruction of facial paralysis.
