In comparative physiological evaluations, patients lose up to 40% of trunk flexion strength and 9% of trunk extension strength with loss of both rectus muscles. Subjectively, patients following a bilateral harvest of the rectus muscles, also note a significant decline in functional capacity performing their preoperative activities of daily living. Similarly, numerous breast reconstruction series have reported abdominal bulge

rates of up to 48 percent after pedicled TRAM flap reconstruction.,8–10 Other series have demonstrated that single rectus muscle harvest is well-tolerated with no significant change in post operative functional capacity.[11] Several factors including the patient’s age, concurrent injuries, and post operative functional needs were carefully considered before Selleckchem BGB324 approaching this reconstruction. The extent of lower extremity injury essentially guaranteed some long-term PD0325901 functional limitation that would necessitate upper core strength for ambulation. Severe left shoulder and humeral fracture obviated harvest of the left latissimus dorsi muscle both for concerns of destabilizing the humerus and shoulder, and technical inability to appropriately position the upper extremity intraoperatively. Consideration was given to right latissimus dorsi harvest,

but concern for prolonged necessity for crutch-assisted ambulation given bilateral lower extremity trauma lowered our enthusiasm for this muscle. Radial forearm and anterior lateral thigh flaps were possibilities but suboptimal given size of the defects, and, in the case of the radial forearm flap, additional upper extremity morbidity. RVX-208 The rectus abdominis muscles were appropriately sized and outside any zone of injury. Once again, concerns for sacrifice of core body musculature were considered. Preoperative planning

for this case included a unilateral rectus muscle and unilateral anterior lateral thigh or radial forearm free flaps. Intraoperative examination of the unilateral rectus muscle demonstrated technical ability to perform a split rectus operation yielding two free flaps, one based on the superior system and one on the inferior epigastric system. It has been shown that fasciocutaneous flaps can suppress infection equally well as muscle flaps,[12] and the use of two anterolateral thigh flaps to obviate functional deficits in a young male would have also served as a good option in this case. However, this method would have required harvest of two flaps rather than one, and via this technique we sought to minimize morbidity, although the effectiveness of fascial versus muscle flaps we believe to be equivalent. The rectus abdominis flap first described by Pennington has gained popularity as an excellent choice for lower extremity reconstruction.