The first muscular branch of the deep inferior epigastric artery: An anatomical study and clinical applications

Background: 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. Methods: 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. Results: 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. Conclusion: 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 cm ².