The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients

Daigeler, Adrien; Simidjiiska‐Belyaeva, Maria; Drücke, D.; Goertz, Ole; Hirsch, Tobias; Soimaru, Christian; Lehnhardt, Marcus; Steinau, Hans-Ulrich

doi:10.1007/s00423-011-0823-6

Cited by 70 publications

(64 citation statements)

References 44 publications

(48 reference statements)

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“…Abdominal hernias after TRAM and VRAM are the most significant morbidity, with an incidence rate of about 13% of the cases (49,54). Free muscle flaps may be indicated if local muscle group have been resected, previously injured or irradiated (3).…”

Section: A B a Bmentioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

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Section: A B a Bmentioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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“…Preoperative chemotherapy and radiotherapy did not affect early morbidity. Sunesen et al (13) higher than the level reported by other investigators (10,17). No late morbidity due to incarceration was observed, and the abdominal brace that was provided was not used continuously by many of the patients.…”

Section: Resultsmentioning

confidence: 81%

Primary Abdominal Wall Reinforcement With Synthetic Mesh Following Harvesting Of Vertical Rectus Abdominis Myocutaneous Flaps In Multivisceral Pelvic Resections

Zoucas¹,

Bjarnevik²,

Nätterlund³

2015

JCRC

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Following multivisceral pelvic resections, the pelvis and perineum are often reconstructed using myocutaneous flaps. Abdominal wall defects after harvesting rectus abdominis flaps can be reinforced with mesh. Primary reconstruction using synthetic mesh was presently evaluated. Fifty-eight patients who underwent multivisceral pelvic resection and perineal reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap, January 2004 to February 2014, were retrospectively reviewed. The abdominal wall was reinforced in 26. Demographics, treatment procedures, surgical procedures, length of hospital and ICU stay, early and late morbidity at the recipient and donor sites were recorded. Patients with mesh reinforcement were significantly younger than those without. There were no further significant differences in patient demographics or treatment procedures between the two groups. In 31% of the patients with mesh, surgery was performed on two consecutive days, although total operating time did not differ significantly.Patients without mesh bled more. Surgery was associated with considerable morbidity, without significant differences in overall complication rate between the two groups. At the recipient site, wound infection/ dehiscence was the most common early complication. The group with mesh had higher rate of total flap necrosis necessitating re-operation. At the donor site, wound infection /dehiscence, hernia, or bulge were recorded. Patients with mesh had lower rates of donor site morbidity. Perineal reconstruction with VRAM flap and primary abdominal wall reinforcement with mesh is feasible after multivisceral resection. Our study indicates that primary use of mesh can be applied in potentially contaminated surgical fields in oncologic patients without increasing morbidity and with improved long-term cosmetic results.

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“…Although free flaps play an important role in the management of these defects in otherwise healthy patients, they may require longer operation durations and overburden patients in critical condition, such as those with progressive malignant disease. In these situations, sufficient soft tissue coverage needs to be achieved by simple and reliable techniques with moderate donor site morbidity (10).…”

Section: Discussionmentioning

confidence: 99%

Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps

Uzun¹,

Bitik²,

Baltu³

et al. 2017

Turk J Med Sci

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Background/aim: Resection of tumors from the groin and thigh regions with safe margins often results in significant soft tissue defects, which preclude primary closure. This study presents a series of rectus abdominis myocutaneous flaps for irradiated thigh and groin wounds with the purpose of evaluating the efficacy and outcomes of these flaps in this population. Materials and methods:From 2008 to 2015, all patients who underwent resection of thigh or groin region tumors and reconstruction with an inferiorly based rectus abdominis myocutaneous flap were retrospectively identified. Medical records of the patients were reviewed.Results: A total of 27 patients, aged 20-67 years, were operated on for defects in the groin and upper thigh region. Nine patients underwent immediate reconstruction. The remaining 18 patients underwent late reconstruction. There was neither total flap loss nor partial flap loss. We chose to utilize 15 ipsilateral and 12 contralateral pedicles. The mean length of stay in hospital was 13.7 days. Conclusion:A rectus abdominis myocutaneous flap can be successfully used in patients with groin and upper thigh defects due to its predictable and robust vascular supply, bulky muscle content, wide arc of rotation, and large skin island.

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The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients

Abstract: VRAM flaps are reliable tools for defect coverage in the oncologic patient to prevent chronic ulceration, lymphangitis or more severe complications like septic rupture of femoral vessels and hip disarticulation. Donor site morbidity is tolerable, and patients' satisfaction is high.

Cited by 70 publications

References 44 publications

Materials and techniques in chest wall reconstruction: a review

Materials and techniques in chest wall reconstruction: a review

Primary Abdominal Wall Reinforcement With Synthetic Mesh Following Harvesting Of Vertical Rectus Abdominis Myocutaneous Flaps In Multivisceral Pelvic Resections

Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps

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