Limited incision harvest of the rectus abdominis muscle flap

Rectus abdominis muscle harvest typically uses a long and continuous paramedian approach. To limit donor site morbidity, the senior author performs a limited incision approach particularly useful in medically vulnerable patients, including patients with sternal wound infections.

All patients of a single surgeon from 2000 to 2014 who underwent rectus harvest by one or two transverse incisions and use of lighted retractor were identified. Patients were categorized by indication, for “sternal wound coverage” or “non-sternal wound coverage.” Co-morbidities, operative notes, and post-operative courses were evaluated. Comparisons were made to patients undergoing harvest by paramedian approach.

Seventeen patients with a mean age of 61 underwent limited-incision rectus harvest. Nine patients had indication for “sternal wound coverage.” Three patients had single transverse incision and six patients had double transverse incisions. One patient expired post-reconstruction day 3. One patient had complete abdominal and partial sternal wound dehiscence. No other donor site complications were observed. Eight patients had indication for “non-sternal wound coverage,” including seven patients requiring free rectus for lower extremity defects and one a pedicled rectus abominis for pelvic osteomyelitis. No post-operative complications were observed in these non-sternal wound coverage patients. There was a trend toward improved wound healing and hospitalization time using the transverse compared to paramedian technique, although this was not significant.

The morbidity of the traditional paramedian incision for rectus harvest may be avoided using a limited skin incision approach. This is useful in patients with attenuated healing capacity and offers a lower risk approach to a traditionally risky donor site.

Level of Evidence: Level IV, therapeutic study.