Online Atlas of Microsurgery

An atlas of microsurgery techniques and principles.

Inner Thigh Flap

The Transverse Upper Gracilis (TUG) Flap

Anatomic considerations

A skin, fat and muscle flap. The skin paddle can be from 11 cm wide up to 25 centimeters long.
Branch from the obturator nerve to gracilis is not used unless a functional muscle transplant is needed.
Blood supply:
Gracilis vessels from the medial femoral circumflex system.
Usually small caliber, from 1 to 2 mm.
Two venae, one usually slightly larger than the artery.
Pedicle length:
6 to 8 centimeters long.


The cutaneous perforators of the gracilis muscle supply both the anterior and posterior inner thigh skin reliably. The transverse orientation of the flap allows for a large skin paddle, with some independence from the muscle below.

Anatomy of the Tug Flap

The perforator for the transverse upper gracilis flap travels through the gracilis muscle. The muscle is small and expendable, with no resultant hernia formation or bulging after removal.

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