Versatility of Rectus Abdominis Myocutaneous Flap in Primary Reconstruction of Defects in Surgical Oncology

With the advent of microvascular surgery, the choice of reconstruction following resection of the primary has an important bearing on the final functional and cosmetic outcome in surgical oncology. The vertical rectus abdominis myocutaneous (VRAM) flap is arguably the most widely used and versatile flap in reconstructive surgery. All patients undergoing a VRAM flap reconstruction following resection of their tumor in the Surgical Oncology Department of a tertiary cancer center from 2012 to 2019 were included in the study. Defects ranged from the breast (40), head and neck (10), groin (3), and perineum (5). The primary outcome measure was incidence of complete and partial flap necrosis, while incidence of hematoma, seroma, incisional hernia, wound dehiscence, and infection were secondary outcomes measured. The patients were followed up for a minimum period of 1 year. The incidence of complete flap necrosis was 5.1% (3) and partial loss 12% (7). Incidence of minor complications such as seroma was 13.7% (8), hematoma 6.8% (4), wound dehiscence 10.3% (6), and wound infection 5.1% (3). Incisional hernia and donor site wound-related complications were not seen in any. On binary regression analysis, the presence of diabetes mellitus, smoking, and the use of adjuvant treatment were associated significantly with increased odds of flap loss. This study demonstrates the versatility and reliability of the VRAM flap in primary reconstruction of defects in surgical oncology. Optimization of risk factors such as diabetes, smoking, and weight gain can reduce flap loss and improve outcomes.