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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Partial Muscle Transplantation, a Strategy for the Preservation of Form and Function at the Donor Site
Darrell Brooks, MD, Rudolf F. Buntic, MD.
California Pacific Medical Center, San Francisco, CA, USA.

Purpose: There has been a recent trend towards transplantation of perforator flaps and away from muscle flaps given the attendant loss of function with muscle harvest. We acknowledge the importance of perforator flaps, but continue to recognize significant advantages of muscle transplantation in certain patients. These include superior color match in head/neck resurfacing , filling of complex dead spaces, contour reconstruction in patients with thick perforator flaps, and the ability to provide simultaneous resurfacing and reanimation. The purpose of this study is to describe the design and transplantation of the partial superior latissimus dorsi (PSL) and partial medial rectus abdominis (PMR) muscle flaps in such situations while preserving form and function at their donor sites.
Methods: This is a retrospective review of partial muscle flaps transplanted by two surgeons between 2003 and 2006. Charts were reviewed to define indications for tissue transplantation, characteristics of the transplanted tissue including muscle volume, neurovascular pedicle length and diameter, outcome analysis, maintenance of donor site form/function, as well as, patient complaints/complications.
PSL Harvest
The superior aspect of the latissimus dorsi flap is harvested with the transverse branch of the thoracodorsal neurovascular pedicle. The majority (>70%) of the muscle is left intact with adequate blood supply and persistent innervation from the longitudinal branch of the thoracodorsal nerve (FIG 1a).
PMR Harvest
The medial aspect of the rectus muscle is harvested with the deep inferior epigastric artery (DIEA). The majority (>50%) of the width of the rectus abdominis muscle is left intact with adequate blood supply and persistent innervation via the intercostals nerves (FIG 1b).
Results: Twenty-two PSL muscle flaps have been performed to reconstruct arm/hand (7), leg/foot (11), and head/neck (4) defects. Fifteen PMR muscle flaps have been performed to reconstruct chest wall (1), arm/hand (6), and leg/foot (9) defects. Specific uses included segment bone cover during staged ilizarov reconstruction (3 PSL, 4 PMR), reanimation (4PSL), and exposed knee prosthesis salvage (2PSL). Characteristics of the flaps based on recipient site requirements are shown (Table 1).
All muscle flaps survived. Follow-up examination has ranged from 6-36 months. All patients were very satisfied with their donor scar. None complained of post-operative pain or weakness. Examination revealed preservation of function of the residual muscle without associated hernia or diastasis after PMR or early arm fatigue or changes in strength related to activities involving arm extension after PSL. The lateral thoracic silhouette was maintained in all cases.
Conclusion: Partial harvest of the superior latissimus or medial rectus muscle can provide comparable muscle volume to complete harvest of the rectus or gracilis muscle respectively without the attendant loss of function. The PSL and PMR flaps should be considered excellent alternatives to perforator flaps when the advantages of muscle use is desired.

Table 1. Characteristics of PSL and PMR muslce vs. avg. rectus and gracilis muscle characteristics
FlapMuscle VolumePedicle LengthPedicle DiameterFlap + PrdicleNerve
Rectus Abdominis180 cm27-14cm1-3.5mm37-44cmN/A

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