(1)
Yotsuya Medical Cube, Chiyoda-ku, Tokyo, Japan
Basic Principles
The inguinal region has an excess of skin so there are few cases with insufficient skin. However the femoral blood vessels run beneath the inguinal ligament, so in the case of a large and deep skin or soft tissue defect, the reconstruction of this region becomes extremely important. This is because insufficient tissue directly above the femoral blood vessels can cause the femoral blood vessels to rupture, and such an event may prove fatal. Therefore, in the case of tissue lost above the femoral blood vessels it is essential to reconstruct healthy tissue as soon as possible.
Common causes for the loss of subcutaneous soft tissue in the inguinal region are wound dehiscence following a lymphadenectomy and lymph fluid rhea.
Muscle flap is often chosen for use as the tissue flap because it has ample tissue and is resistant to infection.
Selectable Flaps and Surgical Procedures
Rectus abdominis musculocutaneous flapTensor fascia latae flapRectus femoris muscle flapGracilis muscle flapAnterolateral thigh flapThe difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.
12.1 Rectus Abdominis Musculocutaneous Flap (Level of Difficulty: 4)
Information
Vascular pedicle Deep inferior epigastric blood vessels
Size All of rectus abdominis muscle for muscle flap section. For the skin flap section, if the perforator of the navel flank can be included, a sufficient amount can be obtained so that the skin flap can be reefed in all directions.
Advantage It is possible to obtain a stable blood circulation using a long and thick vascular pedicle. Highly suited to reconstruction requiring that needs to be covered using muscle.
Disadvantage Abdominal hernia following removal of the rectus abdominis muscle is a major problem. Various methods have been reported, however reconstruction using the Components Separation Method is the most stable and simple method.
12.1.1 Operation Procedures
Fig. 12.1
Procedure 1: Raw surface after lymphoma resection in right inguinal region
Fig. 12.2
Procedure 2: Following tumor resection, damage is assumed to have occurred to the right deep inferior epigastric blood vessels. Therefore the rectus abdominis musculocutaneous flap was designed using the contralateral deep inferior epigastric blood vessels as the vascular pedicle
