OP158: The perforator-based rectus abdominis transplant: New reconstructive advantages from an old friend

Abstract

Purpose To describe three advantages of the perforator-based rectus abdominis transplant: a long pedicle that reduces the need for vein grafts, moldable fat ideal for custom-designed flaps, and volume for constrained spaces. Material and methods Eleven patients underwent reconstruction with the perforator-based rectus abdominis transplant from May 2011 to July 2012. Indications for reconstruction were tumor ablation in nine patients and osteoradionecrosis in two patients. There were seven oral cavity defects, two maxilla defects, one anterior cranial base defect, and one orbital defect. Six patients had prior neck dissection and one had prior chemoradiation. Results The success rate of transplantation was 91%; one patient had a flap failure. Mean pedicle length was 14.5 cm. No vein grafts were utilized, and in four patients (36%) with defects distant from the neck and/or vessel-poor necks the pedicle length directly avoided the need for vein grafting. In all 11 patients, at least one reconstructive advantage was achieved. In six patients (55%), at least two advantages were achieved. In three patients (27%), all three advantages were accomplished. Conclusions The perforator-based rectus abdominis transplant provides at least three major reconstructive advantages for patients who require complex head and neck reconstruction.