[Anatomic study and advantages of the free rectus abdominis flap for head and neck reconstruction].
BACKGROUND
The main goal of using the free flap is to be able to carry out extensive surgical resection resulting in good functional outcome. The aims of this study were to define the best area for free rectus abdominis harvest and to assess its value in head and neck reconstruction.


METHODS
Twenty rectus abdominis flaps were studied in ten fresh cadavers. A review of the literature of the free rectus abdominis flap in head and neck reconstruction yielded the main recipient sites and complications (flap necrosis and postoperative abdominal hernia). A reconstruction was performed after near total glossectomy.


RESULTS
With seven perforators and four cutaneous branches of intercostal nerves, the paraumbilical region is the best area to harvest this flap. The rectus abdominis free flap seems to be adapted for near total glossectomy reconstruction. Previous studies reported that this flap was essentially used for oropharynx and skull base reconstruction. The main complications are flap necrosis (4%) and abdominal hernia (3%).


CONCLUSIONS
The paraumbilical rectus abdominis free flap is reliable and easy to use with a two-team approach in head and neck reconstruction with moderate donor site morbidity. It is useful for reconstruction of large defects of the oropharynx and skull base. Sensory-motor reinnervation superiority for deglutition in tongue reconstruction still needs to be evaluated.
Michel
F
F
Service d'Oto-rhino-laryngologie, de chirurgie cervico-faciale et plastique, Hôpital Bellevue, CHU de Saint-Etienne, 42055 Saint-Etienne, France. fredmichelorl@hotmail.com
Prades
J M
JM
Merzougui
N
N
Timoshenko
A
A
Martin
C
C
D002102:Cadaver; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005145:Face / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000033:anatomy & histology* / Q000601:surgery*; D013524:Surgical Flaps