• Archives of Reconstructive Microsurgery
• /
• v.4 no.1
• /
• pp.23-32
• /
• 1995

Severe upper and lower extremity trauma may result in soft tissue loss with exposed bone and the subsequence of risk of chronic osteomyelitis or malunion of fracture fragments. Such injuries present a major reconstructive problem. But Since the introduction of microsugical technique, free muscle and myocutaneous flaps were employed to provide coverage of severely injured defects. Since Tai and Hasegawa(1974) first reported a breast reconstruction using by rectus abdominis myocuraneous flap, the free rectus myocutaneous flap has been widely employed for breast reconstuction, head and neck reconstruction, and extremity reconstruction in these days. The authors present their successful experience with free rectus abdominis muscle and rectus abdominis myocutaneous flaps for upper and low extremity reconstruction. From Nov. 94, to May 95, Five cases of severely injured extremites due to trauma or contact burn were treated with free rectus abdominis muscle flap or free rectus abdominis myocutaneous flap. All flaps except 1 case were survived without severe complications. As free muscle or myocutaneous flap, the free rectus abdominis flap has the advantages of a reliable pedicle, easy dissection, and an acceptable donor site, so it seems logical to apply the free rectus abdominis flap to apply in upper and lower extremity reconstruction.

• Archives of Reconstructive Microsurgery
• /
• v.5 no.1
• /
• pp.80-91
• /
• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Archives of Reconstructive Microsurgery
• /
• v.11 no.2
• /
• pp.141-145
• /
• 2002

Rectus abdominis muscle free flap is widely used for breast reconstruction and soft tissue defect in lower leg but donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. Recently, to minimize donor-site morbidity, there has been a surge in interest in deep inferior epigastric perforator(DIEP) free flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. Between August of 1995 and September of 2002, topographic investigation of DIEP was performed during the elevation of 97 cases of TRAM free flap and 5 cases of DIEP free flap. There were 84 cases of breast reconstructions, 12 cases of lower leg reconstructions, and 6 cases of head and neck reconstruction. We could observe total 10 to 12 perforators on each rectus abdominis muscle below umbilicus. Among these, the numbers of large perforators(>1.5mm of diameter) were mean 2.1 in lateral half of rectus abdominis muscle, mean 1.2 in medial half, and mean 0.5 in linea alba and paramedian. DIEP free flap provides ample amount of well vascularized soft tissue without inclusion of any rectus abdominis muscle and fascia and minimizes donor-site morbidity. One perforator with significant flow can perfuse the whole flap. For large flap, a perforator of the medial row provides better perfusion to zone-4 than one of lateral row and, if diameter of perforator is small, $2{\sim}3$ perforators can be used. According to the condition of recipient-site, thin flap can be harvested. As DIEP free flap has many advantage, perforator topography will be useful in increasing clinical usage of DIEP free flap.

• Archives of Reconstructive Microsurgery
• /
• v.13 no.1
• /
• pp.68-73
• /
• 2004

Transverse rectus abdominis muscle (TRAM) free flap is widely used for breast reconstruction, however donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. For the purpose of minimizing donor-site morbidity, there has been a surge in interests in muscle sparing free TRAM flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. The purpose of this study is to investigate complication and morbidity after muscle sparing free TRAM flap. Between August, 1995 and May, 2003, there were 108 cases of muscle sparing free TRAM flap of breast reconstruction. There was no abdominal hernia. There were 4 cases of dog ear, 3 cases of marginal necrosis of apron flap, 2 cases of asymmetry of umbilicus. At 1 year after operation, most patients feel comfortness in physical exercise. Muscle sparing free TRAM flap provides ample amount of well vascularized soft tissue with small inclusion of rectus abdominis muscle and fascia. Also it minimizes donor-site morbidity with rapid recovery of abdominal strength.

• Archives of Plastic Surgery
• /
• v.35 no.4
• /
• pp.480-482
• /
• 2008

Purpose: Unexpected vascular anomaly can make the surgeon embarrassing and even affects on the operative results of free flap reconstruction. We experienced one case of abnormal course of deep inferior epigastric vessels during the elevation of rectus abdominis musculocutaneous free flap for breast reconstruction. Methods: A 38-year-old female patient who had modified radical mastectomy on her left breast underwent delayed breast reconstruction with rectus abdominis musculocutaneous free flap. Results: Flap elevation was performed in the traditional manner. During the flap elevation, it was detected that the deep inferior epigastric vessels ran between the rectus abdominis muscle and anterior rectus sheath along the midline after traversing the rectus muscle. The reconstructive surgery was successful and there were no postoperative complications. Conclusion: This is the first case reported in Korea. We should always know about the possibilities of unexpected anomaly that we can encounter.

• Archives of Reconstructive Microsurgery
• /
• v.5 no.1
• /
• pp.92-98
• /
• 1996

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

• Journal of Yeungnam Medical Science
• /
• v.28 no.2
• /
• pp.116-123
• /
• 2011

The incidence of breast cancer, the second most prevalent cancer type in South Korea, has increased by 6.8% annually in the last six years. The higher number of breast cancer patients has led to an increase in the cases of skin-sparing mastectomies, thereby increasing the need for reconstructive procedures. The reconstruction options include alloplastic techniques such as implant or autologous reconstruction with numerous flaps. The abdominal area is the preferred donor site for the harvest of autologous tissue for breast reconstruction. Breast reconstruction using abdonimal tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing TRAM, DIEP, and SIEA flap techniques were later developed in an effort to decrease the abdominal-donar-site morbidity by decreasing the injury to the rectus abdominis muscle and fascia. This article summarizes the various abdominal flaps for breast reconstruction.

• Archives of Reconstructive Microsurgery
• /
• v.19 no.1
• /
• pp.29-36
• /
• 2010

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.34 no.5
• /
• pp.367-375
• /
• 2012

Midfacial reconstruction following resection of extensive malignant oral cavity tumors constitutes a challenging problems for reconstructive surgeons. Rectus abdominis muscle free flap (RAMFF) can be considered as the optimal reconstructive option in this case, because this flap has some advantages including consistent deep inferior epigastric artery anatomy, easy to dissect with well defined skin boundaries, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with oral cancer ablation surgery. The rectus abdominis muscle forms an important part of the anterior abdominal wall and flexes the vertebral column, which is a long strap-like muscle divided transversely by three tendinous intersections, fibrous bands which are adherent to the anterior rectus sheath, which is thickly enclosed by the rectus sheath, except for the posterior part below the arcuate line that is usually located midway between the umbilicus and symphysis pubis. Below the arcuate line, this muscle lies in direct contact with the transversalis fascia and parietal peritoneum. For the better understanding of RAMFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings muse be learned and memorized by the young doctors in the course of the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article will discuss the anatomical basis of RAMFF with Korean language.

• Archives of Plastic Surgery
• /
• v.32 no.2
• /
• pp.183-188
• /
• 2005

Defect on the temporal area caused by, surgical ablation of a tumor or an infection should be reconstructed immediately to prevent potentially life-threatening complications such as meningitis and cerebrospinal fluid leakage. The defect on the temporal area usually presents as a typical 'cone-shape'. Successful reconstruction requires sufficient volume of well-vascularized soft tissue to cover the exposed bone and dura. From 1994 through 2003, the authors applied rectus abdominis free flap for the reconstruction of the temporal defect from 1994 through 2003. There were 10 patients with a mean age of 52.1 years. Of these 10 patients, external auditory canal cancer was present in four patients, temporal bone cancer in two, parotid gland cancer in one and three patients were reconstructed after debridement of infection(destructive chronic otitis media). All the free flaps survived, and flap-related complications did not occur. Compared to a local flap, the rectus abdominis free flap can provide sufficient volume of well-vascularized tissue to cover the large defect and can be well-tolerated during an adjuvant radiation therapy. The long and flat muscle can be easily molded to fit in to the 'cone-shape' temporal defect without dead space. It is also preferred because of the low donor site morbidity, a large skin island and an excellent vascular pedicle. Two-team approach without position change is possible. In conclusion, the authors think that rectus abdominis free flap should be considered as one of the most useful method for the reconstruction of a cone-shaped temporal defect.