Perineal reconstruction using pedicled vertical rectus abdominis myocutaneous flap (VRAM)

Abstract

The vertical rectus myocutaneous flap (VRAM) is a relatively simple and reliable technique for perineal wound reconstruction after abdominoperineal resection.

Primary vs myocutaneous flap closure of perineal defects following abdominoperineal resection for colorectal disease: a systematic review and meta‐analysis

“…Amongst these studies, 118 studies were excluded for the following reasons: one animal study; four studies included other tumour types; 49 studies just reported one surgical regimen or technical material; 17 studies were reviews, letters, editorials; 11 studies lacked full text or data; nine studies were non-English articles; 27 studies were case reports. Finally, 18 studies including one RCT and 17 cohort studies published between 1948 and 2017 were included in this systematic review and meta-analysis [8,11,14,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

“…Additionally, for the overall population, there were 1990 patients (12.17%) receiving preoperative radiotherapy in the primary closure group and 425 patients (27.12%) in the myocutaneous flap closure group, with a significant difference between the two groups. Among these included studies, one performed the propensity matching analysis, four matched BMI, 12 matched comorbidities and six matched preoperative radiotherapy [8,[26][27][28][29][30][31][32][33][34][36][37][38][39][40]. Nine studies on stage of cancer had the following distribution: low tumour stage (I-II) (252 cases in primary closure, 1.54%; 101 cases in myocutaneous flap closure, 6.45%) and advanced tumour stage (III-IV) (312 cases in primary closure, 1.91%; 124 cases in myocutaneous flap closure, 7.91%) [8,26,28,30,[32][33][34]38,39].…”

“…Therefore, the myocutaneous flap cohort had significantly more patients with advanced stage cancer. Twelve studies only conducted APR [8,14,[26][27][28][29]32,33,36,38,40] and eight studies only adopted the vertical rectus abdominis myocutaneous (VRAM) flap closure technique [8,26,28,[33][34][35]38,40]. The type of myocutaneous flaps used in the eligible studies included VRAM, gluteal flap, gracilis flap, thigh flap, V-Y flaps and fasciocutaneous flap.…”

Closure of the perineal defect after abdominoperineal excision for rectal adenocarcinoma – ACPGBI Position Statement

“…Touny conducted a single centre RCT randomising 60 patients that received neo‐adjuvant long‐course chemoradiotherapy (CRT) to either primary closure of the perineum or vertical rectus abdominus myocutaneous (VRAM) flap reconstruction after cAPE. Significantly higher rates of wound infection, abscess, delayed healing or wound dehiscence were reported amongst the primary closure group (46.6% vs 17.2%, P = 0.015) . This result is subject to performance and detection bias due to the inability to blind the surgeon and assessors.…”

Methods of reconstruction of perineal wounds after abdominoperineal resection. Literature review

“…провели рандомизиро-ванное проспективное исследование [20]. Аналогично описанным выше, в группы сравнения (с использова-нием VRAM-лоскута и без аутопластики) вошли паци-енты, перенесшие БПЭ (все получали химиолучевую терапию); в каждую группу вошли по 30 больных.…”