In 1970 Tamai et al. described the successful transplantation of the rectus femoris muscle in dogs. Harii et al. (1975) first reported the clinical use of muscle transplantation with vascular anastomosis, using the gracilis muscle to reconstruct an established facial paralysis. The upper third of the gracilis muscle can be exposed through an incision approximately 10 cm in length on the inner surface of the thigh. The motor branch supplying the muscle is derived from the obturator nerve and passes cranial to the vessel pedicle into the muscle. The vascular branch of the pedicle, branches of the profunda femoris artery, and accompanying veins, lie somewhat distal to the nerve (see Fig. 122). A third incision, a hand’s breadth above the knee joint, exposes the distal portion of the muscle, allowing the muscle to be totally removed.