Outcome and Complications Following Vertical Rectus Abdominis (VRAM) Flaps to Reconstruct Sacrectomy Defects

Introduction: The vertical rectus abdominis (VRAM) flaps has been used to reliably reconstruct posterior soft tissue defects following resection of high sacral tumors, providing skin and soft tissue bulk to fill the potential space following sacral resection. Current literature examining the use of the VRAM flap for high sacral reconstruction is limited. The purpose of this study was to report our institutions outcome on the use of the VRAM flap to reconstruct a high sacral defect following an oncologic resection. Method: 87 (29 females, 58 males) patients underwent a VRAM flap to reconstruct a posterior wound following high sacral tumor resection from 1994 to 2016. The mean age and BMI were 52 years and 27.8 kg/m2. The mean follow-up was 6 years. Forty-seven patients had a history of neoadjuvant radiotherapy and twenty-eight had intraoperative radiotherapy. Results: 68 (79%) patients sustained a complication, most commonly a wound complication (n=41, 47%). 20 (23%) patients sustained a donor site wound complication, most commonly a wound dehiscence (n=10). Complications resulted in a reoperation in 44 (51%) patients, with total flap failure occurring in 1 (1%). Preoperative radiotherapy and obesity were found to increase the risk of wound complications (P=0.004, P=0.02) and deep infection (P=0.03, P=0.02). Conclusion: Complications including flap failure following VRAM were common. Patients with obesity and preoperative radiotherapy should be cautioned on their increased risk of complications. Currently the VRAM has is our preferred means of soft tissue reconstruction following high sacral tumor resection. ¥ Co-First Authors COI: No conflicts of interest are declared by any author on this study. Source of funding: No disclosures of funding were received for this work from NIH, Welcome Trust, or HHMI. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research § Corresponding Author ©2018American Society of Plastic Surgeons

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