Pg. Cordeiro et E. Santamaria, THE EXTENDED, PEDICLED RECTUS-ABDOMINIS FREE TISSUE TRANSFER FOR HEADAND NECK RECONSTRUCTION, Annals of plastic surgery, 39(1), 1997, pp. 53-59
The rectus abdominis musculocutaneous free tissue transfer has become
a mainstay of reconstruction for large defects in the head and neck. T
he length of the deep inferior epigastric vessel is traditionally acce
pted to be 8 to 10 cm from its origin to its entrance into the rectus
muscle. This pedicle is usually not long enough for reconstruction of
the upper midface, forehead, and cranial base if vascular anastomosis
to the neck vessels is necessary. Vein grafts have been recommended un
der these circumstances. We have been able to extend the length of the
vascular pedicle by intramuscular dissection of the lateral branch of
the deep inferior epigastric artery and veins in 26 clinical cases. T
he dissection is carried along the posterior surface of the muscle, up
to the first tendonous inscription. Intraoperative measurements of th
e pedicle length before (6.9 +/- 1.0 cm) and after (13.7 +/- 2.0 cm) d
issection, as well as in 17 fresh cadavers (34 muscles), demonstrate t
hat the pedicle length can be increased safely from 7.8 +/- 0.5 cm to
17.7 +/- 0.52 cm (range, 15.8 to 19.1 cm). This long-pedicled flap has
been used successfully in 26 patients for reconstruction of different
types of defects in the head and neck, without using vein grafts.