Endoscopic Harvesting of Free Muscle Flaps

  • R. Gröner
  • E. Biemer
Part of the Update in Plastic Surgery book series (UPDATEPLASTIC)


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. 1.

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

  2. 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.



Latissimus Dorsi Muscle Flap Rectus Sheath Latissimus Dorsi Flap Perforator Vessel 
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  1. Bass LS, Karp NS, Benaquista T, Kasabian AK (1995) Endoscopic Harvest of the Rectus Abdominis Free Flap: Balloon Dissection in the Fascial Plane. Ann Plast Surg 34: 274–280PubMedCrossRefGoogle Scholar
  2. Bostwick J III, Nahai F, Wallace JG, Vasconez LO (1979) Sixty latissimus dorsi flaps. Plast Reconstr Surg 63: 31PubMedCrossRefGoogle Scholar
  3. Boyd JB, Taylor GI, Corlett R (1984) The Vascular Territories of the Superior Epigastric and the Deep Inferior Epigastric Systems. Plast Reconstr Surg 73: 1–14PubMedCrossRefGoogle Scholar
  4. Fine NA, Orgill DP, Pribaz JJ (1994) Early chnically experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg 33: 465PubMedCrossRefGoogle Scholar
  5. Friedlander LD, and Sundin J (1996) Minimally Invasive Harvesting of Rectus Abdominis Myofascial Flap in the Cadaver and Porcine Models. Plast Reconstr Surg 97: 207–211PubMedCrossRefGoogle Scholar
  6. Friedlander L, and Sundin J (1994) Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg 94: 6Google Scholar
  7. Gröner R, Brunner CA, Geishauser M, Schaff J, Biemer E (1997) Endoscopie Harvesting of the Latissimus Dorsi Muscle Flap — Preliminary Results of Short Term Follow Up. Romanian J Reconstr Microsurg 2(1): 27–29Google Scholar
  8. Gröner R, Geishauser M, Brunner CA, Schaff J, Biemer E (1997) Endoscopic Harvesting of the Latissimus Dorsi Muscle Flap. Eur J Plast Surg 20: 4–6CrossRefGoogle Scholar
  9. Gröner R, Feller A-M, Biemer E (1995) Die Spendermorbidität beim freien Rectus-abdominis-Lappen. Handchir Mikrochir Plast Chir 27: 78–82PubMedGoogle Scholar
  10. Jones NF, Sekhar LN, Schramm VL (1986) Free Rectus Abdominis Muscle Flap. Reconstruction of the Middle and Posterior Cranial Base. Plast Reconstr Surg 78: 471–479PubMedCrossRefGoogle Scholar
  11. Kind GM, Rademaker AW, Mustoe TA (1997) Abdominal Wall Recovery Following TRAM Flap: A Functional Outcome Study. Plast Reconstr Surg 99: 417–428PubMedCrossRefGoogle Scholar
  12. Lejour M, Dome M (1991) Abdominal Wall Function after Rectus Abdominis Transfer. Plast Reconstr Surg 87: 1054–1068PubMedCrossRefGoogle Scholar
  13. May JW Jr, Gallico GG III, Jupiter J, Savage RC (1984) Free latissimus dorsi muscle flap with skin graft for treatment of traumatic chronic bony wounds. Plast Reconstr Surg 73: 641PubMedCrossRefGoogle Scholar
  14. Olivari N (1979) Use of thirty latissimus dorsi flaps. Plast Reconstr Surg 64: 654PubMedCrossRefGoogle Scholar
  15. Pennington DG, Pelly AD (1980) The Rectus Abdominis Myocutaneous Free Flap. Br J Plast Surg 33: 277PubMedCrossRefGoogle Scholar
  16. Russel RC, Pribaz J, Zook EF et al. (1986) Functional evaluation of Latissimus dorsi donor site. Plast Reconstr Surg 78: 336CrossRefGoogle Scholar
  17. Savaizumi M, Onishi K, Maruyama Y (1996) Endoscopic-assisted Rectus Abdominis Muscle Flap Harvest for Chest Wall Reconstruction: Early Experience. Ann Plast Surg 37: 317–321CrossRefGoogle Scholar
  18. Taylor GI (1985) Reconstruction of the Leg with the Rectus abdominis Flap. Presented at: International Meeting of the Microsurgical Society, ParisGoogle Scholar
  19. Zauner-Dungl A, Resch K-L, Herczeg E, Piza-Katzer H (1995) Funktionelle Defizite nach Entnahme des M. rectus abdominis. Handchir Mikrochir Plast Chir 27: 83–88PubMedGoogle Scholar

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© Springer-Verlag Wien 2001

Authors and Affiliations

  • R. Gröner
  • E. Biemer

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