Free Flap in Head and Neck Reconstruction

Following total maxillectomy with orbital exenteration, the defect is reconstructed with vertical rectus abdominis free flap. The length of the flap required is determined by measuring from the top of the orbit down to the hard palate and then across to the buccal mucosa. The width is the distance between the Eustachian tube orifice posteriorly and the nasal spine anteriorly. The flap is raised as a vertical ellipse of abdominal skin perfused by vessels which arise from the inferior epigastric vessels and perforate the rectus abdominis muscle. A large segment of the left rectus muscle is therefore raised with the skin.