Rare origin of the inferior epigastric artery from an anomalous medial circumflex femoral artery.

Correspondence Rare origin of the inferior epigastric artery from an anomalous medial circumflex femoral artery Mathes & Bostwick (1977) surgically manipulated the rectus abdominis myocutaneous flap to repair defects in the anterior abdominal wall. Subsequently this flap was used in breast reconstruction (Robbins, 1981 ; Hartrampf et al. 1982) as a donor for free-tissue transfer (Bunkis et al. 1983) and to repair defects in the groin (Logan & Mathes, 1984 ; Ramasastry et al. 1989). Disadvantages of this flap are that it can be too thick to use effectively and a direct abdominal hernia may occur through the inguinal triangle To overcome these disadvantages the rectus abdominis and the fascia covering the inguinal triangle must be intact. Surgeons therefore harvested the inferior epigastric skin flap for free-tissue skin transfer ; this flap contained little or no rectus abdominis muscle or transversalis fascia (Koshima & Soeda, 1989). Previous investigators determined the anatomical basis for the use of this skin flap and used it to repair defects following resection of ulcers and scar tissue on the head, neck and extremities (Itoh & Arai, 1993). Viability of these flaps is dependent on the integrity of their blood supply following transposition or transplan-tation. Due to its surgical relevance the origin, course, distribution and anomalies of the inferior epigastric artery (IEA) have been studied (Bergman et al. 1984 ; Taylor et al. 1984 ; San4 udo et al. 1993). Previous researchers have shown that, within the greater pelvis, the IEA may arise from a common trunk with the obturator and medial circumflex femoral arteries (San4 udo et al. 1993) or as a common trunk with the deep circumflex femoral artery (Bergman et al. 1984). However, in this male specimen the IEA was a recurrent branch of an anomalous medial circumflex femoral artery (AMC) arising from the external iliac artery (Fig.). As far as the authors are aware this anomaly has not been described. The medial circumflex femoral artery (MCFA) may spring from the profunda femoris or femoral arteries or one of the branches of the external iliac artery (Bergman et al. 1984). This anomalous IEA arose within the femoral triangle and ran superiorly, passing deep to the inguinal ligament, medial to the deep inguinal ring and entered the rectus sheath anterior to the arcuate line (Fig.). Dissection of the right thigh and right side of the anterior abdominal wall of this cadaver revealed that this …