Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction

Malke Asaad; David Mitchell; Cedar Slovacek; Abbas M Hassan; Aashish Rajesh; Jun Liu; Sahil Kapur; Donald Baumann; Charles E Butler

doi:10.1097/PRS.0000000000011233

Surgical Outcomes of Vertical Rectus Abdominis Myocutaneous Flap Pelvic Reconstruction

Plast Reconstr Surg. 2023 Dec 4. doi: 10.1097/PRS.0000000000011233. Online ahead of print.

Authors

Malke Asaad¹, David Mitchell^{1

2}, Cedar Slovacek^{1

2}, Abbas M Hassan¹, Aashish Rajesh¹, Jun Liu¹, Sahil Kapur¹, Donald Baumann¹, Charles E Butler¹

Affiliations

¹ Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² The University of Texas, McGovern Medical School, Houston, TX, USA.

PMID: 38051145
DOI: 10.1097/PRS.0000000000011233

Abstract

Background: The vertical rectus abdominis myocutaneous (VRAM) flap has emerged as the workhorse flap for perineal and pelvic reconstruction. We aimed to evaluate outcomes of VRAM flap over a 20-year period and the role of mesh abdominal wall reinforcement following VRAM flap-based reconstruction.

Methods: We conducted a retrospective review of all consecutive patients who underwent pelvic reconstruction with a VRAM flap between January 2001 and March 2021. Our primary outcome measure included recipient and donor surgical site occurrences (SSOs).

Results: We identified a total of 546 patients (55% females) with a mean age was 58 years and mean BMI was 27 kg/m 2. Mesh was used at the time of VRAM reconstruction to reinforce the abdominal donor site in 36% of patients. Recipient-site SSOs occurred in 38% of patients while donor-site SSOs occurred in 17% of patients. Hernia was identified in 9.9% of patients while bulge developed in 6.4% of patients. Cox proportional hazards regression model for hernia occurrence identified age, BMI, tobacco use (HR 2.03, 95% CI [1.02 - 4.04]) and use as an extended VRAM (HR 2.13, 95% CI [1.04 - 4.36]). The use of mesh or component separation were not independent protective factors for hernia occurrence.

Conclusion: The pedicled VRAM flap is versatile and is our preferred flap for reconstruction of pelvic and perineal defects. The use of mesh/component separation to allow for fascial closure was not shown to reduce donor site hernia occurrence.