The corners of the skin island are marked for removal (viewed from the patient's left). The corners are most distant from the perforating vessels and rely on the subdermal and intradermal plexuses of vessels for viability. The full amount of skin is not necessary for reconstruction, so the areas with the most tenuous blood supply are removed. The purpose of making the flaps ellipitcal in the first place and not isolating only the part to be used is to allow closure of the abdominal defect (tummy tuck) in an esthetic way. Note that the size of the corner removed on the left (farther from the right perforators) is greater than the right.
The rectus muscle was elevated. Note the arcuate line of the posterior rectus sheath, where the division of the internal oblique aponeurosis into anterior and posterior leaves ends. Below the arcuate line, the aponeuroses of the external and internal obliques both go anterior to the rectus, and only transversalis fascia lies beneath the muscle.
Notes:
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