Vram Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision

Version 1 : Received: 30 November 2023 / Approved: 30 November 2023 / Online: 1 December 2023 (08:06:39 CET)
Version 2 : Received: 1 December 2023 / Approved: 1 December 2023 / Online: 1 December 2023 (10:46:42 CET)

A peer-reviewed article of this Preprint also exists.

Faur, I.F.; Clim, A.; Dobrescu, A.; Prodan, C.; Hajjar, R.; Pasca, P.; Capitanio, M.; Tarta, C.; Isaic, A.; Noditi, G.; Nati, I.; Totolici, B.; Duta, C.; Lazar, G. VRAM Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision. J. Pers. Med. 2023, 13, 1711. Faur, I.F.; Clim, A.; Dobrescu, A.; Prodan, C.; Hajjar, R.; Pasca, P.; Capitanio, M.; Tarta, C.; Isaic, A.; Noditi, G.; Nati, I.; Totolici, B.; Duta, C.; Lazar, G. VRAM Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision. J. Pers. Med. 2023, 13, 1711.

Abstract

Due to the still large number of patients diagnosed with pelvic neoplasms (colorectal, gynecological, and urological) in advanced stages right from the initial diagnosis, surgery represents the mainstay of treatment, often implying wide, eventually multi-organ resections in order to achieve negative surgical margins. Perineal wound morbidity, particularly in extralevator abominoperineal excision, leads to complications and local infection rates of up to 40%. Strategies to reduce postoperative wound complications are pursued to address this issue.The VRAM flap remains the gold standard for autologous reconstruction after pelvic oncological resection; it was initially designed for abdominal wall defects and later expanded for large pelvic tissue defects.The flap's application is based on its physical characteristics, including abundant tissue and a generous skin paddle, which effectively obliterates dead space after exenterations. The generous skin paddle offers good cosmetic and functional outcomes at the recipient site.This article describes the case of a patient histopathologically diagnosed with stage IIIA squamous cell carcinoma of the uterine cervix who received multimodal onco-surgical treatment. The surgical mainstay of this treatment is pelvic exenteration. Pelvic reconstruction after this major surgery was performed using a vertical flap with the rectus abdominis.

Keywords

vertical rectus abdominis muscle flap; perineal wound; pelvic exenteration; squamosal cell carcinoma of the uterine cervix; reconstruction

Subject

Medicine and Pharmacology, Surgery

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Received: 1 December 2023
Commenter: Prodan Catalin
Commenter's Conflict of Interests: Author

Comment: There are some changes in the paper. Please update it.

A number of bibliographical references have been updated and text has been added.

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