Free gracilis muscle flap: Variations of obturator nerve

Background: Gracilis muscle has been used in reconstructive surgery for free muscle flap transfer. It was reported to be a reliable flap with lower rates of donor-site morbidity. In this study, we aimed to emphasize the anatomical variations of the obturator nerve. Materials and Methods: Clinical results of 14 patients who underwent lower lip reconstruction and facial reanimation with free gracilis muscle transfer between March 2017 and May 2021 were examined. Results: We identified eight male and six female patients, with a mean age of 55.6 years (range: 37–73 years). Of 14 patients, nine (64.3%) were operated on for lower lip reconstruction, and the remaining five cases underwent facial reanimation. Despite adequate dissection, we could not find the branch of the obturator nerve for gracilis muscle in two cases (14.3%), while vascular pedicles are detected in all cases. The first case was a lower lip reconstruction and the second case was a facial reanimation. Conclusion: While gracilis muscle is a good option for functional muscle transfer, it may be difficult to find the branch of the obturator nerve. Our study may suggest the need for consideration of anatomical variations of the obturator nerve before surgical planning for improved shared decision-making.