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The L-shaped modification of the transverse upper gracilis (TUG) flap

Lookup NU author(s): Adrian Blackburn



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020, The Author(s). A variety of free tissue flaps have been described for autologous breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is most microsurgeons’ first choice, there is no consensus regarding which is the second-best alternative. The transverse upper gracilis (TUG) flap has gained popularity for cases where the abdomen is not a suitable donor site. This musculocutaneous flap has the advantage of an easy dissection, allowing the harvest of tissue from the medial thigh area with the patient supine. However, drawbacks include a tedious donor site closure and a limited amount of soft tissue that can be transferred. The authors hereby present a modification of the TUG flap, introducing an L-shaped skin paddle: the L-shaped upper gracilis (LUG) flap. This alternative allows harvesting extra tissue from the medial thigh, while providing an easier donor site closure with the patient supine. A prospective case series of 14 LUG flaps is presented. No flap failures or episodes of fat necrosis were encountered; only one developed a donor site seroma that settled after drainage. The LUG flap is a useful development of the TUG flap concept providing up to 50% more tissue than a standard TUG flap with an aesthetically pleasing donor site closure which is useful for cases in which abdominal flaps are not possible. Level of evidence: Level IV, therapeutic study.

Publication metadata

Author(s): Berner JE, Henton JMD, Blackburn A

Publication type: Article

Publication status: Published

Journal: European Journal of Plastic Surgery

Year: 2020

Volume: 43

Pages: 837-842

Print publication date: 01/12/2020

Online publication date: 11/04/2020

Acceptance date: 24/03/2020

Date deposited: 02/08/2021

ISSN (print): 0930-343X

ISSN (electronic): 1435-0130

Publisher: Springer Nature


DOI: 10.1007/s00238-020-01662-8


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