scholarly journals Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice

2021 ◽  
Vol 11 (11) ◽  
pp. 1076
Author(s):  
Raymund E. Horch ◽  
Ingo Ludolph ◽  
Andreas Arkudas ◽  
Aijia Cai
Keyword(s):  
Soft Tissue ◽  
Rectus Abdominis ◽  
Skin Paddle ◽  
Wound Breakdown ◽  
Pelvic Malignancies ◽  
Urethral Orifice ◽  
Vram Flap ◽  
Surgical Options ◽  
Perineal Region ◽  
Vertical Rectus Abdominis Myocutaneous

Non-healing extensive wounds in the perineal region can lead to severe soft tissue infections and disastrous complications, which are not manageable with conservative measures. Specifically in recurrent or advanced pelvic malignancies, irradiation often leads to extensive scarring and wound breakdown, resulting in significant soft tissue defects during surgical tumor excision. Among several surgical options to reconstruct the perineum, the transpelvic vertical rectus abdominis myocutaneous (VRAM) flap has proven to be one of the most reliable methods. Specific modifications of this flap allow an individualized procedure depending on the patient’s needs. We modified this technique to include the urethral orifice into the skin paddle of VRAM flaps in three patients as a novel option to circumvent urinary diversion and maintain an acceptable quality of life.

scholarly journals Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

Sarcoma ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Haitham H. Khalil ◽  
Ahmed El-Ghoneimy ◽  
Yasser Farid ◽  
Walid Ebeid ◽  
Ahmed Afifi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Rectus Abdominis ◽  
Skin Paddle ◽  
Musculoskeletal Sarcoma ◽  
Lower Trunk ◽  
Vram Flap ◽  
Ischemic Events ◽  
Proximal Lower Limb

Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds.Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases).Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches.Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

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 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.

Soft Tissue Sarcoma in the Thigh and Groin. Reconstruction using Vertical Rectus Abdominis Myocutaneous Flap

2014 ◽  
Vol 92 (10) ◽  
pp. 693-694
Author(s):  
María Teresa Sánchez Medina ◽  
Jaime Lima Sánchez ◽  
Javier Fernández-Palacios ◽  
Orlando García Duque
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Myocutaneous Flap ◽  
Rectus Abdominis ◽  
Rectus Abdominis Myocutaneous Flap ◽  
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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