Vulvar reconstruction in post-RT case using the versatile VRAM flap: reporting the rare extrapelvic approach

Area of Science:

• Surgical Oncology
• Reconstructive Surgery
• Gynecologic Oncology

Background:

• Flap reconstruction is not standard for vulvar cancer, despite potential benefits.
• Vulvar cancer treatment often involves vulvectomy, potentially requiring reconstruction.
• Neoadjuvant chemoradiation can precede surgery for advanced vulvar cancer.

Observation:

• A patient with vulvar cancer involving the urethra and perineal body underwent neoadjuvant chemoradiation.
• Severe grade IV dermatitis occurred post-radiation, leaving a significant perineal defect.
• The defect required reconstructive surgery due to its size and location.

Findings:

• Successful vulvar reconstruction was achieved using an extrapelvic vertical rectus abdominis myocutaneous (VRAM) flap.
• The VRAM flap provided adequate coverage and bulk for the irradiated perineal defect.
• The well-vascularized flap facilitated healing in a previously irradiated area.

Implications:

• The extrapelvic VRAM flap is a viable and reliable option for vulvar reconstruction after cancer treatment.
• This technique is particularly advantageous for repairing defects in irradiated tissues.
• Utilizing well-perfused muscle flaps can improve outcomes in complex perineal reconstructions.