Journal of Tissue Engineering and Reconstructive Surgery ›› 2026, Vol. 22 ›› Issue (4): 348-.

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Anatomical basis and technical points of free lower abdominal flap transplantation using the distal end of the inferior abdominal wall vascular pedicle as the pedicle

  

  • Online:2026-08-10 Published:2026-09-08

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Abstract:

Objective To explore the anatomical basis and technical points of a free lower abdominal skin flap graft
using the distal end of the inferior abdominal wall vascular pedicle as the pedicle. Methods Retrospective analysis was conducted on the clinical data of 43 patients （43 sides） with breast cancer who underwent free lower abdominal flap transplantation using the distal end of the inferior epigastric artery as the pedicle between April 2019 and April 2025. All patients were female， ranging in age from 24 to 54 years， with a mean age of 28.7 years. Among them，36 cases underwent immediate breast reconstruction， and 7 cases underwent delayed breast reconstruction. The proximal end of the intrathoracic vessels was selected as the recipient vessel in all cases. In the flap preparation group， the dissection of the free lower abdominal flap was completed first； After exposing the perforating vessels， these were dissected to the plane where they anastomose with the main trunk of the inferior epigastric artery. The distal end of the infraportal vascular pedicle was dissected antegradely to a sufficient length. The proximal end of the contralateral infraportal vascular pedicle was then ligated and transected at the segment following the confluence of the perforating vessels. ICG fluorescence  angiography was used to assess flap perfusion； After confirming that the flap received a reliable blood supply via the distal end of the infraportal vascular pedicle， the distal end was ligated. The pedicle length was （5.4±0.5） cm， and the arterial
diameter was （0.9±0.2） mm. 25 cases had two accompanying veins， and 18 cases had one accompanying vein. The selected larger vein for anastomosis had a diameter of （1.2±0.3） mm. The flap was then transferred to the recipient site， and the distal end of the subcutaneous pedicle was anastomosed to the proximal end of an intra-thoracic vessel on the affected side. In all cases， only one artery and one vein were anastomosed. Results All flaps took well with no significant complications， and all patients successfully completed comprehensive treatment， including postoperative radiation therapy. During a follow-up period of 18 to 47 months （mean 31.4 months）， no local tumor recurrence or distant metastasis was observed. The affected limbs remained flexible， with no significant limitations or signs of lymphedema， and abdominal wall function was not significantly impaired. Patient satisfaction was high. Conclusion Breast reconstruction using a free lower abdominal flap with a pedicle originating from the distal end of the infraportal vascular pedicle increases the technical difficulty of the procedure， but does not compromise the flap’s blood supply and significantly reduces damage to the donor site.

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