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Deep inferior epigastric (DIE) vessels, important to vascular apastomosis of an inferior rectus abdominis free flap, were studied clinicoanatomically. This study included morphologic and morphometric examinations of the DIE artery and vein. Bifurcations of the DIE vessels, venous valves, the inner diameters of the DIE vessels, and their lengths were recorded. The following results were obtained:1. Morphologic examination: 1) In the artery, single type (no bifurcation of the DIE artery observed) accounted for 72%. 2) In the vein, single type (no bifurcation of the DIE vein observed) accounted for 2%, distal type (two companion veins of the DIE vein come together to form one trunk before joining the external iliac vein) 33%, medial type (two companion veins of the DIE vein come together just at the point of joining the external iliac vein) 14%, and direct type (two companion veins of the DIE vein join the external iliac vein independently) 2%. 3) The DIE artery anastomosed with the superior epigastric artery in the upper abdomen. 4) Numerous surface branches of DIE arteries were evident in the paraumbilicas region. 5) Most venous valves were bicuspid. 6) Most venous valves were at the bifurcation in the distal type.2. Morphometric examination: 1) The mean inner diameter of the DIE artery 5 mm distal from the DIE artery junction was 1.9±0.5 mm. 2) The mean inner diameters of the DIE veins 5 mm distal from the external iliac veins were 1.7±1.1 mm in the medial type, 2.5±1.5 mm in the distal type, 2.1±1.1 mm in the direct type, and 2.6 mm in the single type. 3) The maximum mean length of artery that could be used as a vascular pedicle was 12.3±2.5 cm.

We described our experience with a recurrent case of buccal cancer in which reconstruction was performed with a skin-grafted rectus abdominis flap. The patient was a 61-year-old woman. She had been undergone tumor excision and reconstruction with a D-P flap at 54 years of age (histopathological diagnosis, acinic cell carcinoma). Recurrence occurred 7 years later. We planned to excise the tumor and perform reconstruction with a rectus abdominis flap. A rectus abdominis flap was prepared before tumor excision, at the same time, free skin was grafted to the raw surface of the flap. Three weeks later, the tumor was excised, and reconstruction was performed. The rectus abdominis flap covered with skin was positioned so that the skin side of the flap formed the cheek and the graft side formed the oral wall. Fat reduction of the flap was performed 18 days later. The flap was successfully transplanted without any necrosis. The outcome was excellent because the flap resembled the natural curve of the cheek. This method is useful for secondary reconstruction and for reconstruction after excision of benign tumors or slowly progressing cancers, such as salivary grand carcinomas.

Recently, microvascular tissue transplantation has come to be generally used for oral and maxillofacial reconstruction. The present status of clinical use of microvascular tissue transplantation for maxillofacial lesions was investigated at 335 oral and maxillofacial surgery centers in Japan. The number of reported was cases 687. Among these, 497 (72.4%) received forearm flap transplantation. A rectus abdominis flap was employed in 104 cases (15.2%). The total survival rate of all transplants was 89.1%