THE FREE RECTUS FEMORIS MUSCLE FLAP AS A VERSATILE FLAP OPTION FOR LOWER EXTREMITY RECONSTRUCTION

Lower Limb Free Rectus Femoral Muscle flap

Abstract

Background: Reconstruction of extensive lower extremity defects, especially those of the distal third of the leg, continues to pose a reconstructive challenge to plastic surgeons. Free flaps have been described as the gold-standard for these reconstructions, with commonly preferred options including the free anterolateral thigh and latissimus dorsi flap. In our experience, the free rectus femoris flap is a good alternative, owing to its technical ease of harvest, satisfactory pedicle length and calibre, and minimal donor site morbidity. We describe our experience with this flap in twenty-one patients.

Methodology: This was a retrospective study conducted in the Departments of Plastic Surgery of the National Orthopaedic Hospital, Igbobi, Lagos; Lagos State University Teaching Hospital, both in Lagos, Nigeria, and National Orthopaedic Hospital, Dala, Kano; over a three-year period, between January 2019 and December 2022. All surgeries had the first author (AOA) as the lead surgeon. Biodata, indication, site of defect, pedicle length and calibre, duration of surgery, recipient vessels and post-operative complication profile were all assessed.

Results: A total of twenty-one patients were included in the study; 18 males and 3 females, with age range of 8 to 54 years. The majority of the defects were post-traumatic (81.8%), followed by post-sequestrectomy defects for osteomyelitis management (13.6%), while post- extirpation of tumours accounted for the least (4.5%). The average duration of flap harvest was 40 minutes, while average duration of entire surgery was 335 minutes. There was full flap survival in 59% and partial flap loss in 27.7%.  Complete flap loss was recorded in 18.2% of cases. Donor site complications were minor and included superficial wound infection and hypertrophic scarring.