The gracilis muscle is a little used muscle on the inside of the thigh. It receives its blood supply from the side and from above right at its origin in the groin. Therefore it can be mobilized in the thigh and at its end at the knee without impairing its blood supply. The muscle can be turned upwards to be used as a living transposition muscular flap to cover or repair damaged tissue. see figure 1 see figure 2


In the past I have used gracilis plasty for anal sphincter repair. The muscle was brought around the anus in a loop. The (voluntary) muscle was stimulated for permanent contraction (as needed at the anus) with a subcutaneous pacemaker. The electrodes were connected to the nerve of the muscle. When the patients wanted to move their bowels, they just simply had to switch the pacemaker off and discontinue contraction of the muscle. Of course this sounds a lot easier than it is in reality. The muscle transposition was not the problem; the electro stimulation was and electrodes dislocated etc. Today I use this technique still but without stimulation in selected cases to strengthen a weak anal sphincter.


The most frequent use of the gracilis in my practice is for the repair of defects in the perineum, the vagina or the rectum. The main indication is high or complicated rectovaginal fistula or an urethro-rectal fistula. Another indication is a non healing perineal defect following abdominoperineal resection of the rectum and anus or radiation defects.


The living muscle brings healthy tissue into an area of destroyed structures and enhances healing. It can also be used to separate two hollow organs (like rectum and vagina) connected by a troublesome fistula. see figure 3 see figure 4