atlas of microsurgery techniques and principles

Rectus Femoris Flap

Rectus Femoris Muscle Flap

Anatomic considerations

A muscle flap, it can be harvested with the overlying skin to incorporate a skin paddle. The muscle is innervated and can be used for functional reconstruction.
Yes - motor nerve to rectus femoris from femoral nerve, it often enters as two segmental branches.
Blood supply:
Descending branch of lateral femoral circumflex artery.
1.5 to 2.5 millimeters
Slightly larger than artery when taken to the origin.
Pedicle length:
Up to 7 centimeters.

The rectus femoris muscle provides a large donor muscle with a consistent blood and nerve supply, providing a potential strong functional muscle, such as needed with posterior or anterior compartment reconstruction.  The disadvantage of harvest is loss of muscle strength of the thigh.

It is often used as a pedicled flap in reconstruction of the anterior abdominal wall. In this case it is taken with a skin island.

Vascular Anatomy

The blood supply to the rectus femoris is via the lateral femoral circumflex artery descending branch.  This same branch travels to supply the tissue of the anterolateral thigh flap.  The ascending branch goes on to supply the tensor fascia lata muscle.     The lateral circumflex femoral vessels take origin from the profunda femoral system.

Rectus Femoris Vascular Supply and Relationships

Vascular anatomy of the rectus femoris muscle. The artery supplying the flap takes origin from the descending branch of the lateral circumflex femoral artery - the same pedicle that supplies the ALT flap.

The muscle arises from the anterior inferior iliac spine and the ilium just superior to the acetabulum. The insertion is at the patella.

Cross Section of Thigh

Cross section of thigh near distal upper third, distal to the takeoff of the lateral femoral circumflex vessels. The lateral femoral circumflex vessel descends in the space between the vastus lateralis and the vastus intermedius.

Operative Procedure

A line drawn from the anterior superior iliac spine to the mid aspect of the patella denotes the longitudinal axis of the muscle.  The incision is made in a lazy-'s' fashion to expose the required length of muscle.  The pedicle arises just proximal to the junction of the proximal and middle thirds of the muscle.  A skin paddle can be harvested with the width determined by ability to close the thigh with a pinch test, while the length is limited to middle third of the thigh. Cutaneous perforators can be determined with the pencil Doppler.

Design of the Rectus Femoris Optional Skin Island

The incision is made over the muscle in a longitudinal or lazy "s" pattern. A skin island is optional.

The rectus femoris and sartorius muscles are identified deep to the muscular fascia.  The sartorius is retracted medially and away from the leg to expose the areolar plane underneath and to identify the lateral femoral circumflex vessels. The femoral nerve and branches are also identified at this level.

The Pedicle is Traced Medially

The pedicle lies deep to the muscle and can be found lateral or medial, proximally. Eventually, the muscle is retracted laterally and the pedicle can be exposed more easily to its origin.

The muscle is freed of fascial connections on its medial, lateral, deep and superficial surface. It can then be divided proximal and distal to the pedicle and is isolated on the descending branch. The nerve to the muscle is ligated and divided.

The Flap is Isolated

The flap is isolated on the descending branch after the distal and proximal muscle have been transected.

The wound is closed in layers over a suction drain. Ambulation is allowed according to the protocol for the muscle recipient area.