Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

Aim Patients who undergo radical pelvic surgery often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of vertical rectus abdominus myocutaneous (VRAM) flaps due to the balance be...

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Bibliographic Details
Published in:	Colorectal disease Vol. 22; no. 5; pp. 562 - 568
Main Authors:	Proctor, M. J., Westwood, D. A., Donahoe, S., Chauhan, A., Lynch, A. C., Heriot, A. G., Sent‐Doux, K., Creagh, T., Frizelle, F. A., Wakeman, C. J.
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-05-2020
Subjects:	Adult Aged Aged, 80 and over Female flap Health risk assessment Humans Male Middle Aged Morbidity Myocutaneous Flap - transplantation Patients Perineum - surgery Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Radiation therapy Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - methods Rectus Abdominis - transplantation Retrospective Studies Smoking Surgery vertical rectus abdominis myocutaneous (VRAM) Wound healing flap vertical rectus abdominis myocutaneous (VRAM)
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Summary:	Aim Patients who undergo radical pelvic surgery often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of vertical rectus abdominus myocutaneous (VRAM) flaps due to the balance between primary healing and the complications associated with this form of reconstruction. This study aimed to evaluate factors associated with significant flap and donor site related complications following VRAM flap reconstruction for radical pelvic surgery. Method A retrospective analysis of VRAM flap related complications was undertaken from prospectively maintained databases for all patients undergoing radical pelvic surgery (2001– 2017) in two cancer centres. Results In all, 154 patients were identified [median age 62 years (range 26–89 years), 80 (52%) men]. Thirty‐three (21%) patients experienced significant donor or flap related complications. Major complications (Clavien–Dindo ≥ 3) related to the abdominal donor site occurred in nine (6%) patients, while those related to the flap or perineal site occurred in 28 (18%) patients. Only smoking (P = 0.003) and neoadjuvant radiotherapy (P = 0.047) were associated with the development of significant flap related complications on univariate analysis. Flap related complications resulted in a significantly longer hospital stay (P < 0.001). Conclusion Careful patient selection is required to balance the risks vs the benefits of VRAM flap reconstruction. Immediate VRAM reconstruction in patients undergoing radical pelvic surgery can achieve early healing and stable perineal closure; it has a low but significant morbidity. Major flap related complications are significantly associated with smoking status and neoadjuvant radiotherapy and result in a prolonged length of hospital stay.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1462-8910 1463-1318
DOI:	10.1111/codi.14909