title: The first muscular branch of the deep inferior epigastric artery:  an anatomical study and clinical applications.
abstract: 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.
  
  
  CONCLUSIONS
  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 cm2.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Cleveland, Ohio; and Pittsburgh, Pa. From the Department of Plastic Surgery, University Hospitals Case Medical Center, Specialties of Plastic and Hand Surgery, and the Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine.
authors.forename: Hooman T
authors.initials: HT
authors.lastname: Soltanian
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Zochowski
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Chepla
authors.forename: William M
authors.initials: WM
authors.lastname: Swartz
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply*; D000328:Adult; D002102:Cadaver; D019074:Epigastric Arteries / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017568:Rectus Abdominis / Q000098:blood supply*; D013524:Surgical Flaps / Q000098:blood supply*