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The Limited Incision Harvest Of The Rectus Abdominis Flap
David E. Kurlander, MD, Matthew Brown, MD, Bram R. Kaufman
Case Western Reserve University, MetroHealth Medical Center
2015-03-01
Presenter: David Kurlander
Affidavit:
Yes.
Director Name: Hooman Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Rectus abdominis harvest is typically approached through a long and continuous paramedian incision. To limit donor site morbidity the senior author devised a less invasive approach that has been particularly useful in medically vulnerable patients, including patients with sternal wound infections.
Methods: All patients of a single surgeon from 2000-2014 who underwent harvest of rectus by one or two transverse incisions and use of lighted breast retractor were identified. Co-morbidities, operative notes, and post-operative courses were evaluated.
Results: Seventeen patients with mean age of 61 underwent rectus harvest using this technique. Nine patients suffered post-cardiac surgery sternal wound infections and were reconstructed with pedicled rectus flaps. Co-morbidities included diabetes, COPD, CKD, hypertension, atrial fibrillation, obesity, and smoking. Seven patients had harvest of left internal mammary artery (LIMA) during CABG. One patient failed previous bilateral pectoral advancement flaps. Two patients had previous sternal rewiring and three had sternectomy. Approach was through single transverse incision in 3 patients and double transverse incisions in 6 patients. One patient developed post-operative sepsis and expired post-reconstruction day 3. One patient had complete abdominal and partial sternal wound dehiscence, and one had partial sternal wound dehiscence. Seven other patients underwent free rectus flaps for lower extremity defect coverage, and one received pedicled rectus abominis for pelvic osteomyelitis. No post-operative complications were observed in these patients.
Conclusions: The morbidity of the tranditional paramedian incision for rectus harvest may be avoided by using this limited approach. This is useful in patients with attenuated healing capacity.
