Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review

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....

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Bibliographic Details
Published in:	Journal of plastic, reconstructive & aesthetic surgery Vol. 74; no. 3; pp. 523 - 529
Main Authors:	Radwan, Rami W, Tang, Alethea M, Harries, Rhiannon L, Davies, Eleanor G, Drew, Peter, Evans, Martyn D
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-03-2021
Subjects:	APER Exenteration Humans Myocutaneous Flap - transplantation Pelvic Exenteration - adverse effects Pelvic Exenteration - methods Pelvic surgery Pelvis - surgery Perineal defect Perineum - surgery Postoperative Complications - classification Postoperative Complications - etiology Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - methods Rectus Abdominis - transplantation Risk Assessment Treatment Outcome VRAM flap APER Exenteration Perineal defect Pelvic surgery VRAM flap
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Summary:	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. 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. 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%. 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	1748-6815 1878-0539
DOI:	10.1016/j.bjps.2020.10.100