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.

Background and Objective: This is the first study to compare the safety and efficacy of vacuum-assisted biopsy (VAB) using a self-contained hand-held system compared to those of ultrasound-guided and computed tomography-guided core needle biopsy (US-CNB and CT-CNB) and to incisional biopsy (IB).Methods: VAB was performed in an outpatient setting under local anesthesia. Safety, diagnostic accuracy, time, and cost expenditures of biopsy were compared between VAB, US-CNB, CT-CNB, and IB in 211 consecutive patients.Results: VAB was applied in 78 patients, US-CNB in 51, CT-CNB in 45, and IB in 37.Patient characteristics did not differ between groups. Sample volume of VAB was 392.5 mm 3 , 4062 mm 3 for IB, and 25.1 to 34.5 mm 3 for CNB, P < .001. VAB discriminated between malignant and benign lesions with the highest accuracy of 96% and determined sarcoma grading accurately in 95%. VAB and CNB had no complications vs 5% for IB. Duration of VAB was 5 ± 2 minutes, equal to US-CNB and shorter than CT-CNB and IB. Expenditures for VAB were higher than for US-CNB and lower than CT-CNB and IB.Conclusion: VAB is an accurate, safe, cost-effective, and time-saving outpatient diagnostic procedure for patients with soft-tissue tumors and presents a viable alternative to IB.