Breast · Interactive 3D

TUG flap

The transverse upper gracilis (TUG) flap: a transverse ellipse of upper medial thigh skin and fat carried on the gracilis muscle and its proximal pedicle from the medial circumflex femoral vessels — an alternative autologous breast reconstruction when the abdomen is not available.

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What to look at

1Find the transverse crescent of skin and fat lifted from the upper medial thigh with the gracilis segment attached beneath it.
2The pedicle enters gracilis on its deep surface about 8–10 cm below the pubic tubercle: the ascending branch of the medial circumflex femoral artery with two venae comitantes.
3The skin lives on musculocutaneous perforators through the proximal third of the muscle — so the paddle sits high, under the groin crease, not down the thigh.
4Donor scar hidden in the groin crease; the price is a short pedicle (about 6–8 cm, 1.5–2 mm artery), limited volume, and the risk of lymphatic complications and wound breakdown at the medial end.

Hotspots

1Transverse skin paddle — An ellipse of upper medial thigh skin and fat, long axis transverse just below the groin crease; typically up to ~10 cm wide so the donor site closes directly.
2Gracilis — The paddle is carried on the proximal gracilis; the muscle is expendable and its anterior obturator nerve branch can be taken for a sensate or functional transfer.
3Pedicle — Ascending (dominant) branch of the medial circumflex femoral artery, from profunda femoris, entering the deep surface of gracilis 8–10 cm below the pubic tubercle — Mathes–Nahai type II.
4Venae comitantes — Paired veins with the artery; pedicle length is only about 6–8 cm, so recipient vessels need to be close — usually the internal mammary vessels.
5Adductor compartment — The donor bed: adductor longus anteriorly, adductor magnus posteriorly; gracilis is the most superficial medial muscle.
6Donor site — Closed directly like a medial thigh lift; lymphocele, seroma and medial wound breakdown are the characteristic complications.

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