Often remote flaps are needed for coverage of foot and ankle defects. The use of grafts or local flaps is limited by the lack of tissue laxity or adequate recipient bed. The authors have used a small rectus muscle plug which is supplied by a previously undescribed branch of the deep inferior epigastric artery.

In seven patients, free rectus plugs were used to provide soft tissue coverage for defects of the foot and ankle. These flaps were harvested through a transverse lower abdominal incision. A central portion of the muscle was harvested based on a muscular branch of the Deep Inferior Epigastric Artery (DIEA). Lateral and medial muscle strips were preserved. The relationship of the muscular branch to the DIEA were recorded during 20 rectus abdominis procedures in 18 patients. The average branching point from the external iliac artery was 53 (+/- 10) mm. Cadaver dissection of 6 muscles also confirmed these findings. The described branch was present in all cadavers. The branch did not perforate through the muscle to reach the rectus sheath in any of the cases. This suggests that this branch is a true muscular branch.

All procedures were successful without any circulatory problems. The patients had minimal donor site discomfort. The muscle provided excellent contour.

The small free rectus plug raised on the first muscular branch of the DIEA offers an excellent option for soft tissue coverage of small and critical defects. The flap is well vascularized and offers a long  pedicle of relatively large diameter, with low donor site morbidity.