The extended, pedicled rectus abdominis free tissue transfer for head and neck reconstruction

The rectus abdominis musculocutaneous free tissue transfer has become a mainstay of reconstruction for large defects in the head and neck. The length of the deep inferior epigastric vessel is traditionally accepted to be 8 to 10 cm from its origin to its entrance into the rectus muscle. This pedicle is usually not long enough for reconstruction of the upper midface, forehead, and cranial base if vascular anastomosis to the neck vessels is necessary. Vein grafts have been recommended under these circumstances. We have been able to extend the length of the vascular pedicle by intramuscular dissection of the lateral branch of the deep inferior epigastric artery and veins in 26 clinical cases. The dissection is carried along the posterior surface of the muscle, up to the first tendonous inscription. Intraoperative measurements of the pedicle length before (6.9 +/- 1.0 cm) and after (13.7 +/- 2.0 cm) dissection, as well as in 17 fresh cadavers (34 muscles), demonstrate that the pedicle length can be increased safely from 7.8 +/- 0.5 cm to 17.7 +/- 0.52 cm (range, 15.8 to 19.1 cm). This long-pedicled flap has been used successfully in 26 patients for reconstruction of different types of defects in the head and neck, without using vein grafts.