The innervated rectus abdominis flap for quadriceps reconstruction

Area of Science:

• Microsurgery
• Reconstructive surgery
• Neuroplasticity

Background:

• Vertical rectus abdominis myocutaneous (VRAM) and transverse rectus abdominis myocutaneous (TRAM) flaps were historically excluded for reconstructions requiring functional potential due to segmental innervation.
• Segmental innervation was presumed to hinder successful neural anastomoses and functional recovery.

Purpose of the Study:

• To demonstrate that segmental innervation does not preclude successful neural anastomoses in rectus abdominis myocutaneous flaps.
• To show that these flaps can provide functional reconstruction for total anterior thigh compartment defects.

Main Methods:

• A case series review of patients undergoing total anterior thigh compartmentectomy and reconstruction.
• Inclusion criteria: patients treated between December 2009 and February 2016 from a prospective database.
• Utilized innervated rectus abdominis flaps for reconstruction.

Main Results:

• Eleven cases of anterior thigh reconstruction using innervated rectus abdominis flaps were identified.
• Median follow-up was 12 months, with all patients demonstrating reinnervation of the rectus abdominis muscle.
• Muscle power recovery ranged from Medical Research Council (MRC) grade M2 to M5, with six patients achieving M5.

Conclusions:

• Successful functional reconstruction of the anterior thigh compartment was achieved in all patients using the rectus abdominis myocutaneous flap.
• Innervated rectus abdominis myocutaneous flaps are a viable option for anterior thigh reconstruction, overcoming previous concerns about segmental innervation.