Rectus Abdominis Flap

The rectus abdominis muscle arises from the pubic crest and symphysis pubis and inserts into the fifth, sixth, and seventh ribs. The muscle has a dual blood supply from the superior and inferior epigastric arteries; the latter is most commonly used for free tissue transfer. The motor innervation to the muscle is from multiple segmental intercostal nerves. The flap can be harvested with or without a skin paddle, depending on the nature of the defect. After making the proper skin incisions, the superior border of the muscle is transected, and the flap is elevated off of the posterior rectus sheath with one of its motor nerves from cephalad to caudad direction. The vascular pedicle is readily identified on the posterior surface of the muscle and dissected down to its origin at the external iliac vessels. After isolating the pedicle, the muscle is then transected inferiorly off of the symphysis pubis. The vascular pedicle is then transected and the flap is transferred to the face. The muscle insetting and neurovascular anastomosis are performed as described for the gracilis flap. The transverse tendinous inscriptions of the rectus muscle help hold the sutures that are placed through the muscle for anchoring. When reconstructing large skin and soft tissue defects over the parotid region, an ipsilateral rectus myocutaneous flap with the skin paddle placed in an oblique orientation is ideal. This flap design allows the rectus muscle to be suspended between the zygomatic arch and the lip for facial reanimation, and the bulky obliquely oriented skin paddle then provides both skin coverage and soft tissue augmentation over the parotid region.

0 0

Post a comment