Background:
Vertical rectus abdominis myocutaneous (VRAM) flap is the gold standard method of perineal reconstruction following radical pelvic surgery. Radical pelvic surgery is associated with high morbidity due to pelvic complications and non-healing perineal wounds, as a result of non-collapsible pelvic dead space and pre-operative adjuvant radiotherapy insult. VRAM flap reconstruction addresses both issues by obliterating the dead space and introducing healthy non-radiated tissue. However, flap reconstruction complications can include donor site hernias (abdominal wall), perineal hernias and flap specific complications. This study aimed to evaluate the abdominal and perineal hernia rates, as well as radiological evidence of flap vascularity post-operatively.
Methods:
We conducted a retrospective analysis of patients who underwent a VRAM flap reconstruction following radical pelvic surgery at Christchurch hospital between April 2011 and March 2019. We identified the presence of donor site hernias (abdominal wall hernias), perineal hernias and flap vascularity (deep inferior epigastric artery [DIEA]) on a computed tomography (CT) scan at 6 to 24 months post-op. Patients who did not have a post-operative CT were excluded.
Results:
Sixty-seven patients underwent a VRAM flap reconstruction of which 52 patients met the inclusion requirements for the study, (mean age 61 years [range 26 – 89], 28 male and 24 female). Eighteen patients underwent an APR and 34 underwent a partial or a complete pelvic exenteration and the majority of them (77%) were for rectal adenocarcinomas. The donor site hernia rate was 15% and perineal hernia rate was 2%. VRAM flap appeared to have DIEA flow in 94% of the patients.
Conclusion:
VRAM flap reconstruction is the gold standard reconstructive option in reducing morbidity in patients who undergo radical pelvic surgery, with a relatively low risk of donor site or perineal herniae and excellent evidence of sustained vascularity.