Related Experiment Video
Updated: May 23, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Vertical rectus abdominis musculocutaneous flow-through flap to a free fibula flap for total sacrectomy
Patrick B Garvey1, Mark W Clemens, Laurence D Rhines
1Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA. pbgarvey@mdanderson.org
Purpose:
The purpose of this report of a small series was to describe the technique of total sacrectomy reconstruction using a pedicled vertical rectus abdominis musculocutaneous (VRAM) flow-through flap anastomosed to a free fibula flap.
Methods:
We reviewed all consecutive total sacrectomy reconstructions performed from 2009 to 2011. Surgical technique and patient outcomes were assessed.
Results:
Total sacrectomy reconstructions included three two-stage and three-stage VRAM flow-through flap to free fibula flap patients all of which ambulated by discharge. Flap survival was 100%. Pelvic ring defects were reconstructed with A-frame fibula flap struts anastomosed to the distal epigastric vessels of pedicled trans-pelvic VRAM flaps. Complications such as wound healing, infection or hardware failure were not observed. Bony union occurred at an average 2.7 ± 0.6 months.
Conclusions:
Total sacrectomy reconstruction using a VRAM flow-through flap anastomosed to a two-strut free fibular flap allows initial assessment of the recipient vessels during the first and ensuing operative stages, satisfies the bone and soft tissue requirements of the defect, and provides a durable, functionally optimized reconstruction.
