The gracilis muscle (; Latin for "slender") is the most superficial muscle on the medial side of the thigh. It is thin and flattened, broad above, narrow and tapering below.

Structure

It arises by a thin aponeurosis from the anterior margins of the lower half of the symphysis pubis and the upper half of the pubic arch. The muscle's fibers run vertically downward, ending in a rounded tendon. This tendon passes behind the medial condyle of the

femur The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the knee. In many quadrupeds, four-legged animals the femur is the upper bone of the hindleg. The Femo ...

, curves around the medial condyle of the tibia where it becomes flattened, and inserts into the upper part of the medial surface of the body of the

tibia The tibia (; : tibiae or tibias), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two Leg bones, bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outsi ...

, below the condyle. For this reason, the muscle is a lower limb adductor. At its insertion the tendon is situated immediately above that of the

semitendinosus muscle The semitendinosus () is a long superficial muscle in the Posterior compartment of thigh, back of the thigh. It is so named because it has a very long tendon of insertion. It lies posteromedially in the thigh, superficial to the semimembranosus. ...

, and its upper edge is overlapped by the tendon of the sartorius muscle, which it joins to form the pes anserinus. The pes anserinus is separated from the medial collateral ligament of the

knee-joint In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...

by a bursa. A few of the fibers of the lower part of the tendon are prolonged into the deep fascia of the leg.

Relations

By its inner or superficial surface gracilis is in relation with the fascia lata, and below with the sartorius and internal saphenous nerve; the internal saphenous vein crosses it lying superficially to the fascia lata. By its outer or deep surface with the adductor longus, brevis, and magnus, and the internal lateral ligament of the knee-joint, from which it is separated by a synovial bursa common to the tendons of the gracilis and semitendinosus.

Nerve supply

The obturator nerve innervates the gracilis muscle via the lumbar spinal vertebrae.

Function

The muscle adducts, medially rotates (with hip flexion), laterally rotates, and flexes the hip as above, and also aids in flexion of the knee.

Clinical significance

The gracilis muscle is commonly used as a flap in microsurgery. According to the classification of Mathes and Nahai, it presents a type II blood supply, allowing it to be transferred on its artery derived from the medial circumflex femoral artery. This artery enters the muscle about 10 cm from the pubic symphysis. At this point (or 1 cm proximal) the nerve also enters. Gracilis muscle is widely used in reconstructive surgery (graciloplasty), either as a pedicled flap or as a free microsurgical flap. Both pedicled and free flaps can be muscular or musculocutaneous (the so- called "composite flaps"). As a pedicled flap, gracilis muscle can be used in perineal and vaginal reconstruction, after oncological surgery, in the treatment of recurrent anovaginal and rectovaginal fistulas as well in the coverage of the neurovascular bundle after vascular surgery. As a functioning pedicled flap, the gracilis muscle can be transferred for the treatment of anal incontinence. This technique called graciloplasty was described in the 1950s by Pickrell and was revolutionized in the late 1980s by the introduction of chronic muscle electro-stimulation. The gracilis microsurgical free flap is commonly used in the reconstruction of upper and lower limbs, in breast reconstruction and – as a free functioning flap – to restore forearm function or in dynamic reconstruction of facial paralysis.

Transplantation sites

The muscle may be split to reduce bulk for facial reanimation, as well as to repair hand muscles. It can be used to fashion an external anal sphincter.

Additional images

File:Gray235.png, Right hip bone. External surface. File:Gray344.png, Structures surrounding right hip-joint. File:Gray430.png, Muscles of the iliac and anterior femoral regions. File:Gray434.png, Muscles of the gluteal and posterior femoral regions. File:Gray549.png, The left femoral triangle. File:Gray827.png, Nerves of the right lower extremity. Front view. File:Anatomical dissection6.JPG, Gracilis muscle File:Slide3rrr.JPG, Gracilis muscle File:Slide3www.JPG, Gracilis muscle File:Slide8CCCC.JPG, Gracilis muscle File:Slide4FFFFF.JPG, Gracilis muscle File:Slide6LLLL.JPG, Gracilis muscle File:Slide3WWWW.JPG, Gracilis muscle File:Slide11WWWW.JPG, Gracilis muscle File:Slide2DADE.JPG, Muscles of thigh. Lateral view. File:Slide2EA.JPG, Muscles of thigh. Cross section.

References

External links

* - "Muscles of the anterior (extensor) compartment of the thigh." * - "Muscles that form the superficial boundaries of the popliteal fossa." * {{DEFAULTSORT:Gracilis Muscle Hip adductors Hip flexors Thigh muscles Medial compartment of thigh