Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review
Rami W Radwan1, Alethea M Tang1, Rhiannon L Harries1
1Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom.
Background:
The vertical rectus abdominis myocutaneous (VRAM) flap is an established technique employed to reconstruct pelvic and perineal defects not amenable to primary closure. The aim of this study was to systematically review the morbidity of VRAM flap reconstruction following exenterative pelvic surgery.
Materials And Methods:
A systematic literature search was conducted by using Medline, EMBASE, and Cochrane databases. Abstracts of all studies published from inception to November 2019 were identified. Search terms used included 'vertical rectus abdominis myocutaneous', 'vertical rectus abdominis musculocutaneous' and 'VRAM'. Only studies that described outcomes when a VRAM flap was used during exenterative pelvic surgery were included; case reports were excluded. The primary outcome measure was VRAM flap morbidity. Secondary outcome measures included donor site morbidity and hospital length of stay.
Results:
Sixty-five studies with a total of 1827 patients were identified and included. Perineal reconstruction was most commonly performed following abdominal perineal excision of the rectum (APER) (n = 636 and 34.8%). Median patient age at surgery ranged from 38 to 78 years. Mean perineal flap morbidity was 27%, with a complete flap loss rate of 1.8% and a perineal hernia rate of 0.2%. Mean donor site morbidity was 15%, with an abdominal dehiscence rate of 5.5% and an incisional hernia rate of 3.3%.
Conclusions:
While overall morbidity after VRAM flap reconstruction in pelvic visceral surgery is high; the risk of major complications remains low. These data are important when counselling patients for surgery.
Insights
The vertical rectus abdominis myocutaneous (VRAM) flap is a common pelvic reconstruction method. While overall morbidity is high, major complications are rare, offering valuable insights for patient counseling.
Area of Science:
- Surgical Reconstruction
- Pelvic Surgery Outcomes
- Flap Reconstruction
Background:
- Vertical rectus abdominis myocutaneous (VRAM) flaps are used for pelvic and perineal defects.
- Exenterative pelvic surgery often requires complex reconstruction.
- VRAM flaps are an established technique for these challenging defects.
Purpose of the Study:
- To systematically review the morbidity associated with VRAM flap reconstruction.
- To assess outcomes following exenterative pelvic surgery using VRAM flaps.
- To evaluate flap and donor site complications and hospital stay.
Main Methods:
- Systematic literature search of Medline, EMBASE, and Cochrane databases up to November 2019.
- Inclusion criteria focused on studies reporting VRAM flap use in exenterative pelvic surgery (excluding case reports).
- Primary outcome: VRAM flap morbidity; Secondary outcomes: donor site morbidity, length of stay.
Main Results:
- 65 studies with 1827 patients were included.
- Mean perineal flap morbidity was 27% (complete loss 1.8%, hernia 0.2%).
- Mean donor site morbidity was 15% (dehiscence 5.5%, incisional hernia 3.3%).
Conclusions:
- Overall morbidity for VRAM flap reconstruction in pelvic surgery is significant.
- However, the risk of major complications is low.
- These findings are crucial for patient preoperative counseling.
