Inferiorly based rectus abdominis flaps in critically ill and injured patients

Use of the rectus abdominis muscle as a free or pedicled flap is generally well tolerated by patients and accomplishes its intended purpose with minimal morbidity. In chronic or nonacute situations, high rates of success of tissue transfer and low donor site morbidity is expected. We have reviewed our results in 26 patients undergoing inferiorly based rectus abdominis muscle flaps with particular attention to the donor site. Patients with multiple injuries, who have had recent abdominal laparotomy, have a significantly higher morbidity rate. Dehiscence of the abdominal wound in 3 patients and a mortal donor site infection in 1 patient after transfer of a rectus flap has led to a careful examination of the cause for these complications. Careless closure of the midline laparotomy wound with subsequent elevation of a rectus flap lends itself to ischemia of the fascia and potential dehiscence. This is especially true in seriously ill patients on ventilators with abdominal distention and nutritional compromise. Alternate sources of tissue should be used if practical in these patients.