Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v4i4.5582
Abstract
Objective: To demonstrate the versatility of the vertical rectus abdominis flap in the reconstruction of the defects up to 25 cm. This flap provides a large volume. Clinical Case: A 72-year-old male patient with Merkel cell carcinoma in the suprapubic region and another 54-year-old male patient with scrotal squamous cell carcinoma, they are rare entities. The defects were obtained after the surgical resection, 15 cm x 10 cm and 22 cm x 11 cm respectively, using a left vertical rectus abdominis muscle flap for the reconstruction in both of the cases, with 100 % viability. Polypropylene ® mesh was used in the donor area. Conclusion: This flap is versatile and safe in the primary reconstruction of a wide range of defects in the surgical oncology, providing large volume and a long pedicle that can be adapted to the defect.
Keywords
flap; myocutaneous; reconstruction; cancer; surgery
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[14] Schellerer V, Bartholomé L, Langheinrich M , Grützmann R , Horch R, Merkel S, et al. Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction. World J Surg. 2021;45(1):132-140.
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[17] Sunesen K, Buntzen S, Tei T, Lindegaard J, Norgaard M, Laurberg S. Perineal healing and survival after salvage surgery for anal cancer: 10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous flap (VRAM). Ann Surg Oncol. 2009;16(1):68-77.
[18] Dinner M, Labandter H, Dowden R. The role of the rectus abdominis myocutaneous flap in breast reconstruction. Plast Reconstr Surg.1982;69(2):209-215.
[19] Horch R, Hohenberger W, Eweida A, Kneser U ,Weber K , Arkudas A, et al. A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration. Int J Colorectal Dis. 2014;29(7):813-823.
[20] Gordon M, Castro J, Rincón N, Palacios L, Rincón R. Reconstrucción de gran defecto de pared abdominal utilizando el colgajo VRAM en forma bilateral. Rev Venez Oncol. 2009;21(3):146-150.
[21] Álvarez RLM. Tumores de células de Merkel. Rev Med de Cos Cen. 2015;72(617):737-740.
[22] Medranos G, Álvarez H, Magos N, Alemán L, García S. Carcinoma de células escamosas del escroto. Rev Mex Urol. 2017;77(3):219-224.
[2] Kitano D, Osaki T, Sakakibara S, Nomura T, Hashikawa K, Terashi H. Perineal reconstruction with pedicled rectus abdominis myocutaneous flap after posterior pelvic exenteration -A 3D model study. Int J Surg Case Rep. 2021;80:105629.
[3] Amo A, Calvo F, Alonso A, Pérez T. Colgajo miocutáneo de recto abdominal vertical (VRAM): reconstrucción pélvica, vaginal y perineal tras resección abdominoperineal. Cir. plást. iberolatinoam. 2019;45(2):183-187.
[4] Beier J, Croner R, Lang W, Arkudas A, Schmitz M, Gohl J, et al. Prevention of complications in oncological surgery of the pelvic region: Combined onco-surgical and plastic reconstruction measures. Chirurg. 2015;86(3):242-250.
[5] Telich J, Leyva P, Martínez S, Pérez L, Silva R. Reconstrucción perineal con colgajo tipo VRAM posterior a una resección abdominoperineal por carcinoma anal. Cir Plast. 2016;26(3):146-149.
[6] McMenamin D, Clements D, Edwards T, Fitton A, Douie W. Rectus abdominis myocutaneous flaps for perineal reconstruction: Modifications to the technique based on extensive experience from a single center. Ann R Coll Surg Engl. 2011;93(5) :375-381.
[7] De Cicco F, Abrego M, Gallucci G, De Carli P, Boretto J. Colgajo de recto anterior del abdomen para el tratamiento de los defectos de cobertura lumbosacros. Rev Asoc Argent Ortop Traumatol. 2018;83(2):76-84.
[8] Ramírez P, Frumovitz M, Abu-Rustum N, editores. Principios de la cirugía ginecológica oncológica. España: Elsevier; 2019.
[9] Latarjet M, Ruiz A editores. Anatomía Humana. 4ª edición. Argentina: Editorial Médica Panamericana; 2006.
[10] Mirza A, Gopinath K, Amarendra S, Swamy S, Krishna A, Gopinath K. Versatility of Rectus Abdominis Myocutaneous Flap in Primary Reconstruction of Defects in Surgical Oncology. Indian J Surg Oncol. 2020;11(4):740-745.
[11] Zaragoza S. Revisión crítica de técnicas avanzadas de Cirugía Plástica y Reparadora. A propósito de una estancia en Addenbrooke´s Hospital. Disponible en: URL: http://www.oc.lm.ehu.es/Departamento/TFG/TFG%20Sergio%20Zaragoza.pdf.
[12] Horch R, Ludolph I, Arkudas A, Cai A. Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice. J Pers Med. 2021;11(11):1076.
[13] Espinosa A, Arista L, Vergara O, Salgado N. Contralateral Component Separation Technique for Abdominal Wall Closure in Patients Undergoing Vertical Rectus Abdominis Myocutaneous Flap Transposition for Pelvic Exenteration Reconstruction. Ann Plast Surg. 2016;77(1):90-92.
[14] Schellerer V, Bartholomé L, Langheinrich M , Grützmann R , Horch R, Merkel S, et al. Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction. World J Surg. 2021;45(1):132-140.
[15] Houdek M, Bakri K, Tibbo M, Wagner E, Rose P, Sim F, et al. Outcome and complications following Vertical Rectus Abdominis Myocutaneous Flap Surgery to Reconstruct Sacrectomy Defects. Plast Reconstr Surg.2018;142(5):1327-1335.
[16] Campbell C, Butler C. Use of adjuvant techniques improves surgical outcomes of complex vertical rectus abdominis myocutaneous flap reconstructions of pelvic cancer defects. Plast Reconstr Surg. 2011;128(2):447-458.
[17] Sunesen K, Buntzen S, Tei T, Lindegaard J, Norgaard M, Laurberg S. Perineal healing and survival after salvage surgery for anal cancer: 10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous flap (VRAM). Ann Surg Oncol. 2009;16(1):68-77.
[18] Dinner M, Labandter H, Dowden R. The role of the rectus abdominis myocutaneous flap in breast reconstruction. Plast Reconstr Surg.1982;69(2):209-215.
[19] Horch R, Hohenberger W, Eweida A, Kneser U ,Weber K , Arkudas A, et al. A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration. Int J Colorectal Dis. 2014;29(7):813-823.
[20] Gordon M, Castro J, Rincón N, Palacios L, Rincón R. Reconstrucción de gran defecto de pared abdominal utilizando el colgajo VRAM en forma bilateral. Rev Venez Oncol. 2009;21(3):146-150.
[21] Álvarez RLM. Tumores de células de Merkel. Rev Med de Cos Cen. 2015;72(617):737-740.
[22] Medranos G, Álvarez H, Magos N, Alemán L, García S. Carcinoma de células escamosas del escroto. Rev Mex Urol. 2017;77(3):219-224.
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