Abdominal wall reconstruction with an expanded rectus femoris flap.

The expanded rectus femoris flap has several advantages for massive abdominal wall reconstruction. The expanded flap can easily reach the xyphoid, and it has impressive width. The donor site can be closed primarily with an acceptable scar. The muscle remains innervated and functional, which may help prevent bulging. When performing the surgery in conjunction with intra-abdominal procedures, such as fistula repair, a simultaneous two-team approach can be used without awkward positioning. The expansion provides some thinning of the muscle, providing a contour more like that of the native abdomen. Its use should be considered in cases of abdominal wall defects extending above the umbilicus.