Free rectus abdominis muscle flap: advantages in lower extremity reconstruction

Major soft tissue losses of the distal portion of the leg usually require free tissue transfer for reconstruction. We have recently treated seven patients with free rectus abdominis muscle flaps. The rectus abdominis has several advantages over other muscles; these advantages simplify such reconstructions. Elevation of this muscle can be done simultaneously with recipient vessel dissection without the need for patient repositioning. The deep inferior epigastric vessels provide a reliable pedicle of one large artery and two veins of sufficient length to accomplish microvascular anastomosis outside the zone of injury without the use of vein grafts. The size and shape of the muscle conforms well to the defects of many wounds in the leg. There is no functional deficiency from the use of one muscle, and the donor site scar is relatively inconspicuous since the rectus abdominis is harvested through a midline abdominal incision. There have been two complications in this series, one intraoperative flap failure, and one case of recurrent osteomyelitis. There has been no donor site morbidity. We recommend the free rectus abdominis muscle flap for the reconstruction of many complex wounds of the distal portion of the leg.