Versatility of Rectus Abdominis Myocutaneous Flap in Primary Reconstruction of Defects in Surgical Oncology

Surgical management of locally advanced breast cancer: Recommendations of the Brazilian Society of Surgical Oncology

“…After reviewing data from patients with breast cancer (Table 1), excluding possible duplicate publications 44 and publications used for general oncology patients, 54,55 the general rate of necrosis for patients with breast cancer was lower among those treated with myocutaneous flaps (11.3%) than thoracoabdominal flaps (20.2%), as previously reported 32 . No difference was noted in relation to the rate of necrosis between latissimus dorsi (9.9%), classic EOMF (9.5%), and TRAM/VRAM (8.4%) flaps.…”

“…50 One publication described a technical modification that allowed the resection of more extensive areas and was associated with high rates of necrosis, 33 defects, 54,55 with few series describing its use for reconstruction after LABC surgery 53 or closure of the chest wall. 51 In studies evaluating case series exclusively using this flap for primary closure of patients with tumors, 51,54,55 the VRAM rate of necrosis was 11.5%, although it was lower when used exclusively for patients with breast cancer(3.6%). 51 Comparing these flaps, TRAM provides better cosmetic results than the VRAM flap, 53 which may be considered after abdominoplasties.…”

“…After reviewing data from patients with breast cancer (Table 1), excluding possible duplicate publications 44 and publications used for general oncology patients, 54,55…”

“…Thoracoabdominal flaps are described in case series, are easy to perform, do not require the involvement of reconstructive surgeons, and have a higher rate of necrosis than myocutaneous flaps, with variations in the complication rate according to the type of flap 32 . Table 1 reviews previous group publications 32,33 and updated literature 32,33,43,46,48–53 related to the use of flaps for breast cancer treatment or VRAM (vertical rectus abdominis myocutaneous) flaps in oncologic procedures 54,55 . The main complication is necrosis, with no separation according to the type of necrosis (tip necrosis or more extensive), the treatment performed (expectant or reoperation), the rate of reoperation, or the time to the start of the next treatment; these issues should be addressed in future studies.…”

“…32 Table 1 reviews previous group publications 32,33 and updated literature 32,33,43,46,[48][49][50][51][52][53] related to the use of flaps for breast cancer treatment or VRAM (vertical rectus abdominis myocutaneous) flaps in oncologic procedures. 54,55 The main complication is necrosis, with no separation according to the type of necrosis (tip necrosis or more extensive), the treatment performed (expectant or reoperation), the rate of reoperation, or the time to the start of the next treatment; these issues should be addressed in future studies. We highlight a flap described to be used for major defects, the ipsilateral, thoracoabdominal horizontal, dermofat flap (ITADE; Figure 2A, right panel), which allows the closure of areas of moderate size 32 where myocutaneous flaps would generally be used.…”