case_images: PMC2729290_01
case_images: The preparation of the left gracilis muscle flap after perineal incision and closure of the PVF.
case_images: CRM2009-676392.001.jpg
case_images: PMC2729290_01_CRM2009-676392.001.jpg
case_images: fig1
case_images: Now another incision was made at the left medial thigh, the gracilis muscle was identified and secured with a loop (Figure 1).
case_images: The gracilis muscle flap was identified then elevated trough a subcutaneous tunnel.
case_images: CRM2009-676392.002.jpg
case_images: PMC2729290_01_CRM2009-676392.002.jpg
case_images: fig2
case_images: 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)).
case_images: The gracilis muscle flap was interpositioned between the pouch and vagina.
case_images: CRM2009-676392.003.jpg
case_images: PMC2729290_01_CRM2009-676392.003.jpg
case_images: fig3
case_images: 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)).