Upper transverse rectus abdominis flap: the flag flap.

A flap is described that consists of skin from the upper abdomen, based on the ipsilateral rectus muscle and fed by the inferior epigastric vessel (the " flag flap"). The flap has an arc of rotation of 360 degrees, and its safety appears to be equal, and perhaps superior, to the lower transverse rectus abdominis flap. In addition, the " flag flap" avoids the potential disadvantage of creating a hernia below the semicircular line in the lower abdomen. The secondary defect is also acceptable. In all cases direct closure was possible by performing a reverse type of abdominoplasty and placing the scar at the submammary fold. The flap has been used in 8 patients for coverage of postradiation and postexcisional tumor defects in the lower trunk and extremities. The complications have been few, although it is not advised that the flap be used for reconstruction of the upper chest area by stretching the pedicle.