[3, 4] Conversely, Sherman has described the extended deep inferior epigastric artery flap for large lower extremity defects.[5] Most reports of the rectus abdominis free flap identify the deep inferior epigastric artery and vein as the dominant vascular pedicle; however, the superior epigastric artery and vein is consistently encountered in dissection of the free flap and is often of adequate caliber for microanastomoses (1.5–3.0 mm).

Here, we report the use of two free flaps from one rectus muscle for reconstruction of bilateral Gustillo IIIB lower extremity injuries. A split segmental rectus abdominis muscle flap based on the superior deep epigastric vessels was utilized Apoptosis antagonist for one limb, whereas the remaining portion of the rectus muscle based on the deep inferior epigastric was used for the contralateral defect. A similar approach utilizing a single split gracilis flap for reconstruction of bilateral heel wounds has been reported by Sherman.[6,

7] We applied the “split flap” concept to the rectus muscle to preserve our young patient’s contralateral rectus muscle. The patient is a 24-year-old male helmeted motorcycle rider who collided with a cement barrier at 90 mph. On arrival, Glasgow Coma Scale was 15, and the patient was noted to be hemodynamically stable. The initial trauma evaluation was notable for a left lower extremity with only an intact posterior tibialis artery, normal foot sensation, and an open tibial-fibular fracture wound with 4.0 cm of periosteal tibial bone stripping. The right lower extremity BGJ398 purchase had intact foot sensation, Methocarbamol patent anterior, and posterior tibialis arteries, and an open tibial-fibular wound with 8.0-cm periosteal-stripped

tibial bone. The patient also had severe trauma to his left shoulder with concomitant humerus fractures, which were treated nonoperatively. The patient was emergently taken to the operating room for external fixation of bilateral lower extremity fractures (Fig. 1). Initial surgical debridement was performed by our colleagues prior to our consultation. Subsequent definitive radical debridement was performed by our service prior to flap coverage. Following these serial debridements, the patient underwent definitive intramedullary nail fixation of his bilateral low extremity injuries. In our patient, the right lower extremity wound reconstruction was approached first, performing an arterial anastomosis of the inferior epigastric artery to the posterior tibialis artery in end-to-end fashion with a 3.0-mm venous coupler to the venae comitantes. After partly insetting the muscle, the superior epigastric artery was identified and dissected from its intramuscular course. The flap was divided horizontally along a tendonous inscriptions using electrocautery and brought to the contralateral wound.