The gracilis is the most medial thigh muscle, the only two-joint adductor (acting at both hip and knee), and the most commonly harvested muscle for free tissue transfer. As a free muscle flap the gracilis is ideal for facial reanimation (smile reconstruction in facial palsy), foot and ankle reconstruction, and perineal reconstruction. Its long tendon is used for ACL/PCL reconstruction and urethral sling procedures.
| Origin | Inferior body and inferior ramus of the pubis (near the pubic symphysis — immediately medial to the adductor longus) |
|---|---|
| Insertion | Upper medial tibia — pes anserinus (most posterior component) |
| Nerve Supply | Obturator nerve (L2, L3) — anterior division |
| Blood Supply | Medial circumflex femoral and deep femoral arteries |
| Actions | Hip adduction; Knee flexion; Internal rotation of the tibia when the knee is flexed |
|---|
Gracilis free muscle transfer for smile reconstruction: the gracilis is harvested with its neurovascular pedicle (obturator nerve and medial circumflex femoral artery), transferred to the face, and reinnervated by the masseteric nerve (providing ipsilateral bite-activated smile) or a cross-face nerve graft (providing spontaneous contralateral smile-activated symmetry). The donor site produces minimal functional deficit.
The gracilis tendon is palpable in the posteromedial knee just anterior to the semitendinosus, becoming cord-like during resisted knee flexion with the hip abducted.
Gracilis muscle with obturator nerve harvest for facial reanimation in permanent facial palsy — reinnervation by masseteric nerve produces smile function.
