Reconstruction of an Extensive Thigh Defect With the Paraumbilical TRAM Flap

Abstract

Reconstruction of extensive defects after radical resection of soft-tissue sarcomas of the extremities has become an essential part of the limb salvage approach to the management of these tumors. The authors describe the successful use of a paraumbilical transverse rectus abdominis musculocutaneous flap with the pedicle based on the inferior epigastric artery for reconstruction of a 24- x 22-cm soft-tissue and skin defect of the anterior thigh after wide local excision of a recurrent malignant fibrous histiocytoma. The ability to mobilize a large amount of well-vascularized soft tissue from an acceptable donor site, the versatility of flap design, the extensive arc of rotation, and the dependability of the inferior epigastric vascular pedicle are all distinct advantages of using this flap in the reconstruction of massive defects of the thigh.

Using of Pedicled Rectus Abdominis Musculocutaneous Flaps in the Thigh and Lumber Defects

“…[16] Literatürde pediküllü RAM flebi göğüs duvarı, sternum, perine, pelvik, kasık ve vajina rekonstrüksiyonlarında daha yaygın olarak kullanılmasına rağmen [1,2] uyluk bölgesindeki defekt onarımlarında kullanımı daha nadir bildirilmiştir. [3][4][5][6][7][8][9] Brain ve ark. uyluk ve kasık bölgesinde lokalize, çoğunluğunu yumuşak doku sarkomların oluşturduğu ve ameliyat öncesi radyoterapi alan 50 hasta ile en geniş olgu çalışmasına sahip klinik çalışmalarında, yaptıkları 51 RAM flep cerrahisinde total flep kaybının hiçbir olguda rastlanmadığını, sadece iki olguda kısmi flep kaybı gözlemlediklerini, 12 olguda (%24) yara yeri komplikasyonları geliştiğini belirtmişlerdir.…”

“…[1,2] Ancak uyluk bölgesindeki defekt onarımlarında kullanımı daha az yaygın olup [3][4][5][6][7][8][9] sırt bölgesinde kullanımı oldukça nadirdir. [10][11][12][13][14] Çalışmamızın amacı; uyluk ve sırt bölgesinde doku defektleri olan veya femur orta seviyesinde amputasyon sonrası yeterli yumuşak doku desteği olmayan olgularda RAM flebiyle onarımları sunmak, flep hazırlanışındaki teknik detayları ve flebin avantajlarını literatür eşliğinde tartışmaktır.…”

Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

“…The muscular component of the VRAM has been utilized to fill the cavity, provide adequate blood supply, and act as an antibiotic delivery system to resist infection [4, 7] in this high-risk immunocompromosed group of patients. In addition, the presence of valves in veins of the inferior epigastric system and intramuscular lymphatic bundles in the rectus muscle reduces the incidence of venous stasis, oedema, and lymphoedema in the dependant portion of these large flaps [2, 4]. …”

“…Limb salvage remains a major objective in contemporary management of bony and soft tissue sarcomas of the pelvis and lower extremities [1, 2]. Radical oncological salvage procedures performed in this area can develop significant wound complications that result from a high incidence of infection, dehiscence, or flap necrosis aggravated by the paucity of well-vascularized local soft tissue and systemically immune-compromised patients [3–6].…”

Inferiorly Based Vertical Rectus Abdominis Myocutaneous (Vram) Flap for Reconstruction of Large Defect After Wide Excision of Soft Tissue Sarcoma in Pubic Region

“…[5] In addition, presence of valves in veins of the inferior epigastric system and intramuscular lymphatic bundles in the rectus muscle reduces the incidence of venous stasis, oedema and lymphoedema in the dependent portion of these large flaps. [6], [7] The local muscle flaps in this region are often hypovascular and fibrotic rendering them insufficient to provide sufficient soft tissue coverage.…”