The first descriptions of the gracilis muscle as a pedicled flap date back to the 1950s, when Pickrell reported on rectal sphincter reconstruction in children (Pickrell et al., Ann Surg 135(6):853–862, 1952). A few years later, the same authors presented a case with a series of 34 patients, including correction of urinary incontinence using this flap (Pickrell et al., Am J Surg 90(5):721–726, 1955). It took almost two decades, with rising interest in myocutaneous flaps, for more publications to appear reporting new indications of the gracilis flap as a myocutaneous transplant. Orticochea used this flap for cross-leg defect coverage at the medial malleolus (Orticochea, Br J Plast Surg 25:106, 1972), and McCraw et al. presented a series of 22 vaginal reconstructions where he used an elliptic vertical skin island along the axis of the gracilis, which often developed partial necrosis of the most distal parts (McCraw et al., Plast Reconstr Surg 58(2):176–183, 1976).