Abdominal and perineal hernia rates following vertical rectus abdominis myocutaneous (VRAM) flap reconstruction - a supraregional experience
| Autor: | Terry Creagh, Frank A. Frizelle, Chris Fernando, Christopher J.W. Porter, Eric Kim, Wayne Bailey, Andrew McCombie, Tamara Glyn, Christopher Wakeman |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Rectus Abdominis Perineum Abdominal wall High morbidity Vascularity medicine Humans Hernia Perineal hernia Pelvic surgery Aged Retrospective Studies Aged 80 and over Pelvic exenteration Abdominoperineal resection business.industry Middle Aged Plastic Surgery Procedures medicine.disease Myocutaneous Flap Surgery Hernia Abdominal medicine.anatomical_structure Female medicine.symptom business |
| Zdroj: | Journal of plastic, reconstructiveaesthetic surgery : JPRAS. 75(3) |
| ISSN: | 1878-0539 |
| Popis: | Background : Vertical rectus abdominis myocutaneous (VRAM) flap has proven to be a robust reconstruction method following radical pelvic surgery. Radical pelvic surgery is associated with high morbidity due to pelvic complications and non-healing perineal wounds, as a result of non-collapsible pelvic dead space and pre-operative adjuvant radiotherapy insult. VRAM flap reconstruction addresses both issues by obliterating the dead space and introducing healthy non-radiated tissue. However, flap reconstruction complications can include donor site hernias (abdominal wall), perineal hernias and flap specific complications. This study aimed to evaluate the abdominal and perineal hernia rates, as well as radiological evidence of flap vascularity post-operatively. Methods : We conducted a retrospective analysis of patients who underwent a VRAM flap reconstruction following radical pelvic surgery at Christchurch hospital over a 10 year period. We identified the presence of donor site hernias (abdominal wall hernias), perineal hernias and flap vascularity on post-operative radiological imaging performed within 48 months. Results : Seventy-seven patients underwent a VRAM flap reconstruction of which 60 patients met the inclusion requirements for the study (mean age 60.3 years [range 26 – 89], 31 male and 29 female). Eighteen patients underwent an APR and 42 underwent a partial or a complete pelvic exenteration and the majority of them (75.0%) were for rectal cancers. Available imaging were on average 21.6 months post-op (IQR 11.8 - 31.3 months). The donor site hernia rate was 16.7% and perineal hernia rate was 3.3%. VRAM flap appeared to have DIEA flow in 98.3% of the patients. Conclusion : Vertical rectus abdominis myocutaneous flap reconstruction of complex pelvic defects remains a robust method of choice in complex pelvic reconstruction with little morbidity. |
| Databáze: | OpenAIRE |
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