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Identical rectus abdominis donor-site morbidity in compromised and healthy patients
1Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania.
Abstract:
As microvascular capabilities improve, donor-site complications may become of greater concern. This has become an issue, particularly with the rectus abdominis muscle which is unique, as weakening of abdominal-wall integrity is always a potential problem. The author has reviewed all 50 of his pedicled and free-flap transfers of the rectus abdominis muscle, comparing healthy and chronically ill patients, for elective and emergent indications. Twelve percent of patients had donor-site complications, identical for both healthy and ill patients; 11.4 percent of pedicled flaps and 13.3 percent of free flaps had compromised outcomes. Three hernias occurred as major complications, which probably could not have been avoided. Nevertheless, these frequencies were within the range of expected complications, as with any muscle-flap donor site. The merit of this flap at the recipient site usually justified the risks and, in spite of appropriate risks and, in spite of appropriate trepidation regarding this donor site, the benefit of this flap should not be denied, even for the unhealthy patient.
Insights
Rectus abdominis muscle flaps offer significant benefits, but donor-site complications, including hernias, occur in about 12% of patients. These risks are comparable across patient groups and flap types, justifying their use.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
Background:
- Advancements in microsurgery highlight donor-site complications as a growing concern.
- The rectus abdominis muscle flap presents unique challenges due to potential abdominal wall integrity compromise.
Purpose of the Study:
- To evaluate donor-site complications associated with rectus abdominis muscle flaps.
- To compare complication rates between healthy and chronically ill patients undergoing flap transfer.
- To assess outcomes for both pedicled and free rectus abdominis flaps.
Main Methods:
- Retrospective review of 50 rectus abdominis muscle flap transfers (pedicled and free).
- Comparison of complication rates in healthy versus chronically ill patients.
- Analysis of outcomes based on flap type and indication (elective vs. emergent).
Main Results:
- Overall donor-site complication rate was 12%, consistent between healthy and chronically ill patients.
- Flap outcome compromise occurred in 11.4% of pedicled and 13.3% of free flaps.
- Three major complications (hernias) were noted, considered unavoidable.
Conclusions:
- Donor-site complications for rectus abdominis flaps are within expected ranges for muscle flaps.
- The benefits of rectus abdominis flaps at the recipient site often outweigh the donor-site risks.
- This flap remains a valuable option, even for high-risk or unhealthy patients.