• May 2015 Procedural Video

    Diagonal Upper Gracilis (DUG) Flap

    Joseph Dayan, MD

    Released: May 2015


    In this video, Dr. Joseph Dayan performs a Diagonal Upper Gracilis (DUG) Flap dissection on a young woman for delayed breast reconstruction.  The DUG flap is oriented parallel to Langer's lines, allowing for a straight line closure along the line of least tension and can be rapidly elevated in the supine position.  This results in a low risk of potential wound healing complications and a wider flap dimension compared to transversely-oriented flaps such as the TUG or PAP.  In addition, the orientation of the donor site closure contours the thigh, minimizing the risk of a "shark bite" appearance.  The DUG flap is particularly useful in thin patients such as this one or patients who do not have a DIEP flap donor site option.  Chapters of this video include DUG flap markings, flap elevation, recipient vessel preparation, anastomosis, and flap inset.