|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Rectus Abdominis Muscle Transplantation
The rectus abdominis muscle is versatile and well suited for transplantation. It is useful for defects of moderate size requiring well vascularized tissue. The classic defects requiring muscle are similar to those discussed in Chapters 18 and 19. The rectus in situ measures approximately 30 cm x 10 cm. Postharvest contraction limits the useful size to approximately 20 cm x 8 cm. In the microsurgical transplantation scheme, it is useful for defects requiring a muscle between gracilis and latissimus in size.
The rectus muscle can be used alone or as a musculocutaneous flap. The skin island can be oriented in a variety of ways, depending on the defect size and orientation or donor scar preferences. The key to preserving the skin viability is including the large perforators from the rectus muscle, especially around the umbilicus.1
The muscle is long and thin and thus well suited for anterior tibial and ankle defects. The anterior location makes dissection convenient for simultaneous teams working on anterior body defects. Recipient vascular indications are qualified by the pedicle dimensions of the rectus abdominis. The deep inferior epigastric vessels measure 2 to 4 mm in diameter and 6 to 8 cm in length.
The rectus was first described for an infraclavicular defect. It has since been reported for use in the head and neck,3 breast,4 and upper and lower extremities.3,5
Disadvantages of the free flap are few. The abdominal scar is seldom objectionable. It can be minimized by using a low transverse incision. Unfortunately, previous abdominal surgery may have interfered with the vascular pedicle. The muscle can be transplanted on its superior pedicle if the inferior one has been destroyed; however, the superior epigastric vessels are small. Abdominal herniation is of minimal concern because the anterior rectus sheath is preserved. Bunkis, in 60 cases of breast reconstruction, noted only 2 hernias.5 Obese patients are poor candidates for a myocutaneous flap because of the bulk and the unreliable perforators. The segmental nerve supply limits its use for free functional muscle transplants; however, small segments can be used for facial reanimation.6 Skin color match to the head and neck is poor.
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