Abdominal and perineal hernia rates following vertical rectus abdominis myocutaneous (VRAM) flap reconstruction - a supraregional experience

2021 ◽  
Author(s):  
Eric Kim ◽  
Chris Fernando ◽  
Andrew McCombie ◽  
Wayne Bailey ◽  
Frank Frizelle ◽  
...  
Keyword(s):  
Perineal Hernia ◽  
Rectus Abdominis ◽  
Flap Reconstruction ◽  
Vram Flap ◽  
Vertical Rectus Abdominis Myocutaneous

scholarly journals Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction

2020 ◽  
Vol 45 (1) ◽  
pp. 132-140
Author(s):  
Vera S. Schellerer ◽  
Lenka Bartholomé ◽  
Melanie C. Langheinrich ◽  
Robert Grützmann ◽  
Raymund E. Horch ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Myocutaneous Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Rectus Abdominis ◽  
Flap Reconstruction ◽  
Direct Closure ◽  
Vram Flap ◽  
Vertical Rectus Abdominis Myocutaneous

Abstract Background Management of donor site closure after harvesting a vertical rectus abdominis myocutaneous (VRAM) flap is discussed heterogeneously in the literature. We aim to analyze the postoperative complications of the donor site depending on the closure technique. Methods During a 12-year period (2003–2015), 192 patients in our department received transpelvic VRAM flap reconstruction. Prospectively collected data were analyzed retrospectively. Results 182 patients received a VRAM flap reconstruction for malignant, 10 patients for benign disease. The median age of patients was 62 years. 117 patients (61%) received a reconstruction of donor site by Vypro® mesh, 46 patients (24%) by Vicryl® mesh, 23 patients (12%) by direct closure and 6 patients (3%) by combination of different meshes. 32 patients (17%) developed in total 34 postoperative complications at the donor site. 22 complications (11%) were treated conservatively, 12 (6%) surgically. 17 patients (9%) developed incisional hernia during follow-up, with highest incidence in the Vicryl® group (n = 8; 17%) and lowest in the Vypro® group (n = 7; 6%). Postoperative parastomal hernias were found in 30 patients (16%) including three patients with simultaneous hernia around an urostomy and a colostomy. The highest incidence of parastomal hernia was found in patients receiving primary closure of the donor site (n = 6; 26%), the lowest incidence in the Vypro® group (n = 16; 14%). Conclusion The use of Vypro® mesh for donor site closure appears to be associated with a low postoperative incidence of complications and can therefore be recommended as a preferred technique.

Recent Experience with Abdominal Perineal Resection with Vertical Rectus Abdominis Myocutaneous Flap Reconstruction after Preoperative Pelvic Radiation

2009 ◽  
Vol 75 (10) ◽  
pp. 995-999 ◽  
Author(s):  
Marcelo W. Hinojosa ◽  
Dhavan A. Parikh ◽  
Raman Menon ◽  
Garrett A. Wirth ◽  
Michael J. Stamos ◽  
...  
Keyword(s):  
Myocutaneous Flap ◽  
Perineal Wound ◽  
Rectus Abdominis ◽  
Wound Complications ◽  
Recent Experience ◽  
Flap Reconstruction ◽  
Pelvic Radiation ◽  
Rectus Abdominis Myocutaneous Flap ◽  
Perineal Wound Complications ◽  
Vertical Rectus Abdominis Myocutaneous

Abdominoperineal resection (APR) after pelvic radiation can be complicated by an increased rate of difficult to treat perineal wound complications. In an effort to improve postoperative morbidity after APR, myocutaneous flap reconstructions have been used. We review our recent experience with APR with vertical rectus abdominis myocutaneous flap reconstruction (VRAM) after preoperative pelvic radiation. A retrospective review of patients who underwent APR with VRAM reconstruction after pelvic radiation from December 2004 to July 2008 was conducted. Outcome measures included demographics, comorbidities, length of stay, wound complications, and morbidity and mortality. Fifteen patients with a mean age of 61 ± 9 years underwent APR with VRAM reconstruction. Five patients also required posterior vaginectomy with the APR. Indications for APR were rectal cancer (n = 14, 93%) and anal canal cancer (n = 1, 7%). There were no intraoperative complications. Mean estimated blood loss was 635 ± 446 mL and mean intraoperative blood transfusion requirements were 1 ± 2 units. Mean length of hospital stay was 11 ± 4 days. Six (40%) patients had minor perineal wound complications. One (7%) patient had a perineal wound infection requiring reoperation with washout and reapproximation. There was no 30-day or in-hospital mortality. All VRAM flaps remained viable through follow-up. APR with VRAM flap reconstruction after preoperative pelvic radiation can be performed safely with limited wound complications and no mortality.

scholarly journals The vertical rectus abdominis myocutaneous (VRAM) flap is the preferred means of post-mastectomy defect cover for large breast tumours

The Breast ◽  
2011 ◽  
Vol 20 ◽  
pp. S47-S48
Author(s):  
Tse Han Loong ◽  
Yia Swam Tan ◽  
Ern Yu Tan ◽  
Juliana Chen ◽  
Marcus Wong ◽  
...  
Keyword(s):  
Rectus Abdominis ◽  
Breast Tumours ◽  
Large Breast ◽  
Vram Flap ◽  
Defect Cover ◽  
Vertical Rectus Abdominis Myocutaneous

scholarly journals Vertical Rectus Abdominis Myocutaneous-Pedicled Island Flap for Covering Defect of the Suprapubic Area: A Case Report

2021 ◽  
Vol 17 (2) ◽  
pp. 154-157
Author(s):  
Hyun-Dong Yeo ◽  
Jae-Ho Chung ◽  
Seung-Ha Park ◽  
Byung-Il Lee ◽  
Eul-Sik Yoon
Keyword(s):  
Abdominal Wall Defect ◽  
Rectus Abdominis ◽  
Lower Abdomen ◽  
Immediate Reconstruction ◽  
Wall Defect ◽  
Adjacent Tissue ◽  
Vram Flap ◽  
Repeated Surgery ◽  
Flap Elevation ◽  
Vertical Rectus Abdominis Myocutaneous

Immediate reconstruction of defects in the lower abdomen is challenging. We present a successful reconstruction case using a vertical rectus abdominis myocutaneous (VRAM) flap for a radiation ulcer on the suprapubic area following radiation therapy for recurred malignant melanoma. Before flap elevation, we conducted sufficient debridement until pliable healthy tissue was revealed. Afterwards, a 15×9 cm VRAM flap was elevated. We then inserted the flap through a suprafascial tunnel. At 6 months postoperatively, a completely healed aesthetic flap was achieved. This case is meaningful in that it involves a successful reconstruction of a sizable abdominal wall defect of the suprapubic area with unhealthy and unviable adjacent tissue following repeated surgery and chemoradiotherapy.

scholarly journals VRAM steal syndrome – a unique cause of flap necrosis in chest wall reconstruction

2018 ◽  
Vol 100 (3) ◽  
pp. e64-e65
Author(s):  
S Young ◽  
N Pantelide ◽  
S Iyer
Keyword(s):  
Arteriovenous Fistula ◽  
Chest Wall ◽  
Rectus Abdominis ◽  
Chest Wall Reconstruction ◽  
Arterial Supply ◽  
Flap Necrosis ◽  
Flap Loss ◽  
Vram Flap ◽  
Steal Syndrome ◽  
Vertical Rectus Abdominis Myocutaneous

The pedicled vertical rectus abdominis myocutaneous (VRAM) flap is a robust flap, which is considered to be a ‘workhorse’ regional option for chest wall reconstruction. We describe a previously unreported complication of partial flap loss due to ‘steal syndrome’, whereby arterial supply was diverted away from the flap due to dialysis from an ipsilateral arteriovenous fistula.

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