PMC2729290_01
The preparation of the left gracilis muscle flap after perineal incision and closure of the PVF.
CRM2009-676392.001.jpg
PMC2729290_01_CRM2009-676392.001.jpg
fig1
Now another incision was made at the left medial thigh, the gracilis muscle was identified and secured with a loop (Figure 1).
The gracilis muscle flap was identified then elevated trough a subcutaneous tunnel.
CRM2009-676392.002.jpg
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fig2
The left gracilis muscle flap was developed after dissecting the tendon from its inserting point at the pes anserinus (Figure 2(a)). The muscle flap was then elevated through a subcutaneous tunnel and introduced into the cavity between vagina and pouch (Figure 2(b)), where it was sutured into place and fixed on the anal levator muscle, on the puborectal loop as well as on the pelvic peritoneum (Figure 3(a)).
The gracilis muscle flap was interpositioned between the pouch and vagina.
CRM2009-676392.003.jpg
PMC2729290_01_CRM2009-676392.003.jpg
fig3
The muscle flap was then elevated through a subcutaneous tunnel and introduced into the cavity between vagina and pouch (Figure 2(b)), where it was sutured into place and fixed on the anal levator muscle, on the puborectal loop as well as on the pelvic peritoneum (Figure 3(a)). The donor site in the lower extremity was closed in layers over a suction catheter, and the perineal wound was primarily closed (Figure 3(b)).