Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing after Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer

Abstract

VRAM flap reconstruction of the perineum is associated with an increased wound healing rate and may protect against pelvic abscess development. However, procedure-related long-term morbidity is incompletely studied and the procedure should be reserved for selected patients.

A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

“…11,43 In particular, the use of a VRAM flap is well established. 8,30,44 However, studies directly comparing muscle flaps and OP are scarce. A retrospective single institutional study by Lefevre et al 30 -which was included in the present review-found that VRAM flap closure was associated with less perineal morbidity, reduced healing time, and no perineal herniation (0% vs 15.4%; P ¼ 0.0072) if compared with primary layered closure with OP.…”

“…4 Tissue transfer seems to have the greatest potential, but high-quality studies comparing muscle flap closure to other methods of perineal wound closure are warranted. Although VRAM flap closure has been effectively used in selective populations, 8 there remains the issue of donor and recipient site morbidity. 43,47 A smaller flap without donor site problems such as the perineal turnover flap 48 seems attractive.…”

“…These include the use of a biological mesh and several tissue flaps, such as a pedicled omentoplasty (OP) or a vertical rectus abdominis muscle flap (VRAM). [8][9][10] The flaps serve to obliterate the often noncollapsible defect with healthy and well perfused tissue, which has been associated with reduced abscess formation and improved wound healing. 11,12 The omentum is supposedly an ideal option to prevent dead space formation after APR.…”

Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing After Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer

“…We read with interest the manuscript by Spasojevic et al 1 entitled Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing After Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer. Their goal was to determine whether perineal wound healing was better after direct wound closure than with a vertical rectus abdominis musculocutaneous (VRAM) flap repair.…”

Factors associated with the use of vertical rectus abdominus myocutaneous flap reconstruction following abdominoperineal resection for anorectal cancer

“…If the sphincter cannot be preserved due to tumor involvement, or there is a contraindication to radiation, abdominoperineal resection (APR) is indicated 1‐3 . APR is also the mainstay of treatment for locoregional recurrence or persistent disease following primary therapy 4 . While APR has been shown to increase 5‐year survival in patients with local or advanced anorectal cancer, it is also associated with high perioperative morbidity, regardless of the indication (35%) 1,5 .…”