Endoscopic harvest of the gracilis muscle flap

Endoscopic technique is becoming increasing prevalent in plastic surgery and is being explored for use in tissue harvest for microneurovascular transplantation. To advance the art truly, endoscopic technique must provide similar success and complication rates, operative time, and ease of performance as the traditional "open" surgical harvest. We report the successful microvascular transplantation in 6 patients of gracilis muscles harvested with endoscopic guidance. Dissection of the primary pedicle was done through a small proximal incision, and subsequent dissection was accomplished with an endoscope through the primary incision and a small distal incision. This method provides excellent success of transfer and decreased morbidity compared with the open technique. Specifically, the resulting scar from the endoscopic technique is considerably smaller, with just a 5-cm proximal and a 1.5-cm distal scar. The technique is accomplished with standard endoscopic equipment and is learned rapidly. We believe the improved aesthetic outcome makes endoscopic gracilis harvest a preferred technique.