The versatility of free rectus femoris muscle flap: an alternative flap

In the 10-year period from June 1985 to December 1994, 54 free rectus femoris muscle or musculocutaneous flaps were performed at our hospital. It has been one of the most frequently used free muscle flaps in our institution and forms 2% of all free tissue transfers (total, 2,769 cases). In 26 patients, it was used for large wound coverage following debridement or tumor ablation, and in 27 patients, as a functioning free muscle transplantation for brachial plexus palsy or traumatic muscle loss. In one patient the components of the deep aponeurosis, muscle, and overlying skin were used for reconstruction of an abdominal wall defect after neurilemmoma excision. There were two complete failures, one due to diabetic foot infection and one due to venous occlusion. Four had superficial marginal skin necrosis. No significant disability of the donor limb was encountered. Easy approach, rapid harvest, large and reliable overlying skin flap, a single dominant neurovascular pedicle (with large vessel diameter and long motor nerve), easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for free tissue transfer, in addition to the gracilis, rectus abdominis, and latissimus dorsi muscle flap.