Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 20:
Rectus Abdominis Muscle Transplantation
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Ch. 20  Page     1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10
 
  D. The upper and lower muscles are then cut, ligating the superior epigastric artery. As much or as little muscle can be taken as needed. The pedicle is left intact until the recipient site is prepared. The lower end of the muscle should be reattached with a stabilizing "safety" stitch to prevent accidental avulsion of the vascular pedicle while the muscle is awaiting transfer.


Clinical Cases

CASE 1

A 33-year-old woman was pushed from a car and caught her left hand under the tire as the car pulled away.

FIG. 20-01. Initially, all digits were viable.


FIG. 20-02. Fractures of the first metacarpal were evident on x ray.


FIG. 20-03. The wound was debrided and the fractures were stabilized with K-wires.


FIG. 20-04. After another debridement, the wound was clean enough to close. The first metacarpal was plated.


FIG. 20-05. A left rectus muscle transplant was planned.


FIG. 20-06. A midline incision was used because of a previous cesarean section. The muscle was harvested and isolated on its inferior pedicle.

 


FIG. 20-07. The muscle was transplanted to the wrist wound anastomosing the deep epigastric vessels to the dorsal radial artery.


FIG. 20-08. Early result after split-thickness grafting the muscle.


FIG. 20-09. Long-term follow-up. The first web space is contracted. Retrospectively, it would have been better to overcorrect the first web space with a portion of the rectus.


CASE 2

A 35-year-old woman had been punctured on the left ankle by a sting ray months before admission.

FIG. 20-10. Several debridements had been undertaken, but the wound remained unhealed, with exposed structure behind the medial malleolus.


FIG. 20-11. The wound was redebrided.


FIG. 20-12. A right rectus was developed through a low transverse incision. An abdominoplasty was performed after harvesting the muscle, a welcome dividend for the patient.


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