PECULIAR INDICATIONS FOR THE PEDICLED OR FREE RECTUS-ABDOMINIS FLAP IN RECONSTRUCTIVE SURGERY - A REVIEW OF OUR EXPERIENCE

Among all known flaps, the rectus abdominis muscle flap possesses an u nique diversity in flap designs due to the special vascular supply of the abdominal wall. The axial vascularization of the rectus abdominis muscle gives of several musculocutaneous perforators, which are mainly located in the periumbilical region. Abdominal wall skin perfusion is guaranteed by spoke-wheel like vessels arising from these perforators . Subsequently several designs (muscle, myocutaneous and myosubcutaneo us) are possible, by variating the included tissue and the position of the skin island. We described 7 cases were the rectus abdominis muscl e was used as a muscle or myocutaneous nap for reconstruction of large defects. In most cases a pedicled transfer was necessary, possible an d sufficient to reconstruct the difficult defects in various body regi ons. Great amounts of well perfused tissue can be transferred with sti ll possible primary closure of the donorsite. Due to its rich perfusio n and constancy of vascular pattern, it represents an excellent and sa fe pedicled reconstructive procedure for large defects of the thorax, the abdomen, the forearm or the hip and pelvis where free tissue trans fers are impossible or contraindicated. No other local transposition w ould have achieved this goal, due to the lack of volume and mobility. Moreover the flap is ideal for reconstruction of contour defencies due to the abundance of fat, as for example in breast or buttock reconstr uction. However the nap is not the first choice for traumatic and infe cted wounds where fat tissue is not desired.