Abdominal and perineal hernia rates following vertical rectus abdominis myocutaneous (VRAM) flap reconstruction – a supraregional experience. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Kim, Eric; Fernando, Chris; McCombie, Andrew; Bailey, Wayne; Frizelle, Frank; Glyn, Tamara; Porter, Chris; Wakeman, Chris; Creagh, Terry
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 75:Issue 3(2022)
• Page Start: 1158
• Page End: 1163
• Publication Date: 2022-03
• Subjects: Pelvic reconstruction -- VRAM -- Abdominoperineal resection -- Exenteration -- Donor site hernia -- Perineal hernia; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2021.11.002
• Languages: English
• ISSNs: 1748-6815

Abstract

Abstract: Background: Vertical rectus abdominis myocutaneous (VRAM) flap has proven to be a robust reconstruction method following radical pelvic surgery. Radical pelvic surgery is associated with high morbidity due to pelvic complications and non-healing perineal wounds, as a result of non-collapsible pelvic dead space and pre-operative adjuvant radiotherapy insult. VRAM flap reconstruction addresses both issues by obliterating the dead space and introducing healthy non-radiated tissue. However, flap reconstruction complications can include donor site hernias (abdominal wall), perineal hernias, and flap-specific complications. This study aimed to evaluate the abdominal and perineal hernia rates as well as radiological evidence of flap vascularity post-operatively. Methods: We conducted a retrospective analysis of patients who underwent a VRAM flap reconstruction following radical pelvic surgery at Christchurch hospital over a 10-year period. We identified the presence of donor site hernias (abdominal wall hernias), perineal hernias, and flap vascularity on post-operative radiological imaging performed within 48 months. Results: Seventy-seven patients underwent a VRAM flap reconstruction of which 60 patients met the inclusion requirements for the study (mean age was 60.3 years [range 26–89]; 31 were male and 29 were female). Eighteen patients underwent an APR and 42 underwent a partial or a complete pelvic exenteration and the majority of them (75.0%) were for rectal cancers. Available imaging was on average 21.6 months post-operatively (IQR 11.8–31.3 months). The donor site hernia rate was 16.7%, and the perineal hernia rate was 3.3%. VRAM flap appeared to have DIEA flow in 98.3% of the patients. Conclusion: VRAM flap reconstruction of complex pelvic defects remains a robust method of choice in complex pelvic reconstruction with little morbidity.