Endoscopic Harvesting of Free Muscle Flaps

Abstract

The rectus abdominis flap belongs to the most frequently used muscle flaps in plastic surgery for defect reconstruction. A large surgical approach is necessary for its conventional harvesting. The flap may be used as free transplant with microvascular anastomosis for defect reconstruction (Pennington et al. 1980). It is possible to elevate myocutaneous as well as pure muscle flaps (Jones et al. 1986, Taylor 1985). The apphcation of a pure muscle flap leads to a lower morbidity of the donor site, than the application of a myocutaneous flap, because for the latter usually a part of the anterior layer of the rectus sheath has to be removed to guarantee the blood supply for the skin islet (Boyd et al. 1984). Still, for the conventional surgical procedure — also when only the muscle is used — a long skin incision with craniocaudal opening of the anterior layer of the rectus sheath is necessary to expose the muscle sufficiently for the harvesting procedure. This has two major disadvantages:

• 1. The necessary long incision leaves scars the patient has to face every day (Fig. 1).

• 2. The opening of the anterior layer of the rectus sheath has to be carried out over the hole length of the muscle, which has to be removed. The long incision of the rectus sheath with removal of the long abdominal muscle carries the danger of weakening of the abdominl wall, development of hernia, and other conditions particular to each patient have to be taken into account (when supporting facts are added during the first week after surgery). These could be adiposity, chronic bronchitis, constipation or a lack of rest.