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Complications of the 'Enhanced Recovery after Surgery Programme' following pedicled vertical rectus abdominis

Sameena Hassan1, Yu Sin Lau, Graeme Perks

  • 1Department of Plastic and Burns Surgery, Nottingham University Hospitals, Nottingham, UK.

BMJ Case Reports
|February 25, 2014
PubMed

Insights

Enhanced recovery programs can pose risks for patients undergoing VRAM flap perineal reconstruction. Early catheter removal may compromise flap viability, necessitating guideline revisions for improved patient safety and surgical outcomes.

Area of Science:

  • Surgical reconstruction
  • Enhanced recovery protocols
  • Urology

Background:

  • The enhanced recovery program (ERP) is a multimodal perioperative care strategy aimed at reducing surgical stress and length of hospital stay.
  • The pedicled vertical rectus abdominis myocutaneous (VRAM) flap is a reconstructive technique used in perineal surgery.
  • ERP was implemented in our institution in 2006 for colorectal surgical patients.

Observation:

  • A patient undergoing perineal reconstruction with a VRAM flap developed bladder outflow obstruction.
  • This obstruction compromised the viability of the VRAM flap.
  • The complication occurred despite adherence to the enhanced recovery program.

Findings:

  • Early catheter removal, a common component of ERP, can lead to bladder outflow obstruction in VRAM flap reconstructions.
  • Bladder outflow obstruction poses a significant risk to flap viability in this patient population.
  • Current ERP guidelines may not adequately address the specific needs of patients undergoing VRAM flap perineal reconstruction.

Implications:

  • New guidelines are being developed to exempt patients undergoing VRAM flap reconstruction from certain ERP elements, specifically early catheter removal.
  • Avoiding early catheter removal may prevent bladder outflow obstruction and preserve flap viability.
  • These revised guidelines aim to enhance patient safety and optimize outcomes in complex perineal reconstructions.

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