Cleveland, Ohio; and Pittsburgh, Pa. From the Department of Plastic Surgery, University Hospitals Case Medical Center, Specialties of Plastic and Hand Surgery, and the Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine.
Plast Reconstr Surg. 2012 Feb;129(2):463-468. doi: 10.1097/PRS.0b013e31823aec94.
Reconstruction of distal lower extremity defects often necessitates free tissue transfer. Because of its reliable vascular anatomy, pedicle length, and vessel size, the free rectus abdominis flap is widely used for this purpose. To minimize donor-site morbidity, several authors have described a segmental, or "partial," free rectus abdominis flap.
After an initial study in cadavers, measurements of the vascular anatomy of the first muscular branch of the deep inferior epigastric artery were recorded during abdominal wall dissections in 18 patients undergoing free rectus abdominis reconstruction. The partial rectus muscle free flap or "rectus plug" was then used in seven patients to reconstruct lower extremity defects.
The first muscular branch was seen in all 20 dissections. The mean distance to the branch point from the origin of the deep inferior epigastric artery was 53.60 ± 9.63 mm. The branch point occurred before the deep inferior epigastric artery passed under the lateral border of the rectus in five dissections and deep to the muscle in 15. The mean length of the muscular branch was 20.85 ± 4.04 mm, and the mean total pedicle length was 77.0 ± 8.46 mm. The supplied portion of muscle was used successfully to reconstruct lower extremity defects in seven patients; at 1-year follow-up, all had healed with good contour and without donor- or recipient-site complications.
The free rectus plug has minimal donor-site morbidity and a reliable anatomy, and should be considered for coverage of lower extremity defects smaller than 25 cm2.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
重建下肢远端缺损通常需要游离组织移植。由于其可靠的血管解剖、蒂长和血管大小，游离腹直肌皮瓣被广泛用于该目的。为了最大限度地减少供区并发症，一些作者描述了一种节段性或“部分”游离腹直肌皮瓣。
在对尸体进行初步研究后，在 18 例接受游离腹直肌重建的患者的腹壁解剖中记录了腹壁下动脉第一肌支的血管解剖测量值。然后，在 7 例患者中使用部分腹直肌游离皮瓣或“腹直肌栓”来重建下肢缺损。
20 次解剖中均可见第一肌支。从腹壁下动脉起点至分支点的平均距离为 53.60±9.63mm。分支点发生在腹壁下动脉穿过腹直肌外侧缘之前的 5 次解剖中，发生在肌肉深面的 15 次解剖中。肌支的平均长度为 20.85±4.04mm，总蒂长平均为 77.0±8.46mm。所供应的肌肉部分成功地用于重建 7 例下肢缺损患者；在 1 年随访时，所有患者均愈合良好，外形良好，无供区或受区并发症。
游离腹直肌栓供区并发症少，解剖可靠，应考虑用于覆盖小于 25cm2 的下肢缺损。
临床问题/证据水平：治疗，V。
