The vertical and extended rectus abdominis myocutaneous flap for irradiated thigh and groin defects

Brian M. Parrett, Jonathan M. Winograd, Evan S. Garfein, W. P Andrew Lee, Francis J. Hornicek, William G. Austen

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND: Thigh and groin tumors are often treated with limb-sparing surgery and adjuvant preoperative irradiation, frequently resulting in complex soft-tissue defects and wounds. The authors evaluated outcomes after reconstruction of these difficult wounds with the vertical and extended rectus abdominis myocutaneous (RAM) flap. METHODS: A retrospective chart review was performed of 50 consecutive patients who underwent inferiorly based RAM pedicle flaps to reconstruct thigh and groin defects after preoperative irradiation and oncologic resection. Timing of reconstruction, flap design, complications, metastasis/recurrence, and ambulation status were analyzed. RESULTS: Fifty patients (mean age, 56 years; range, 10 to 83 years) underwent 51 RAM flaps. Sixty-three percent of flaps were for immediate reconstruction and the remaining flaps were for secondary coverage after failure of initial closure. There were no perioperative deaths. The median length of hospital stay was 9 days. All flaps survived. The vertical RAM flap was used in 63 percent of cases; the extended RAM flap was used in 37 percent and permitted closure of larger, contralateral, and more distal defects. With a mean follow-up of 28 months, complications included partial flap necrosis [n = 2 (4 percent)], infection [n = 8 (16 percent)], seroma [n = 2 (4 percent)], dehiscence [n = 2 (4 percent)], and donor-site bulge [n = 6 (12 percent)]. Postoperative wound complications were significantly higher in patients who underwent delayed or secondary (47 percent) versus immediate reconstruction (9.4 percent, p < 0.005). Three patients required additional coverage. There was no significant difference in flap complications between the extended and nonextended flap designs. Independent ambulation was achieved in 82 percent of patients. CONCLUSIONS: The vertical and extended RAM flaps provide reliable coverage of irradiated thigh and groin oncologic wounds, with significantly improved results obtained with immediate versus delayed reconstruction.

Original languageEnglish (US)
Pages (from-to)171-177
Number of pages7
JournalPlastic and Reconstructive Surgery
Volume122
Issue number1
DOIs
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Rectus Abdominis
Myocutaneous Flap
Groin
Thigh
Wounds and Injuries
Walking
Length of Stay
Seroma
Necrosis
Extremities
Tissue Donors
Neoplasm Metastasis
Recurrence
Infection
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

The vertical and extended rectus abdominis myocutaneous flap for irradiated thigh and groin defects. / Parrett, Brian M.; Winograd, Jonathan M.; Garfein, Evan S.; Lee, W. P Andrew; Hornicek, Francis J.; Austen, William G.

In: Plastic and Reconstructive Surgery, Vol. 122, No. 1, 07.2008, p. 171-177.

Research output: Contribution to journalArticle

Parrett, Brian M. ; Winograd, Jonathan M. ; Garfein, Evan S. ; Lee, W. P Andrew ; Hornicek, Francis J. ; Austen, William G. / The vertical and extended rectus abdominis myocutaneous flap for irradiated thigh and groin defects. In: Plastic and Reconstructive Surgery. 2008 ; Vol. 122, No. 1. pp. 171-177.
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AB - BACKGROUND: Thigh and groin tumors are often treated with limb-sparing surgery and adjuvant preoperative irradiation, frequently resulting in complex soft-tissue defects and wounds. The authors evaluated outcomes after reconstruction of these difficult wounds with the vertical and extended rectus abdominis myocutaneous (RAM) flap. METHODS: A retrospective chart review was performed of 50 consecutive patients who underwent inferiorly based RAM pedicle flaps to reconstruct thigh and groin defects after preoperative irradiation and oncologic resection. Timing of reconstruction, flap design, complications, metastasis/recurrence, and ambulation status were analyzed. RESULTS: Fifty patients (mean age, 56 years; range, 10 to 83 years) underwent 51 RAM flaps. Sixty-three percent of flaps were for immediate reconstruction and the remaining flaps were for secondary coverage after failure of initial closure. There were no perioperative deaths. The median length of hospital stay was 9 days. All flaps survived. The vertical RAM flap was used in 63 percent of cases; the extended RAM flap was used in 37 percent and permitted closure of larger, contralateral, and more distal defects. With a mean follow-up of 28 months, complications included partial flap necrosis [n = 2 (4 percent)], infection [n = 8 (16 percent)], seroma [n = 2 (4 percent)], dehiscence [n = 2 (4 percent)], and donor-site bulge [n = 6 (12 percent)]. Postoperative wound complications were significantly higher in patients who underwent delayed or secondary (47 percent) versus immediate reconstruction (9.4 percent, p < 0.005). Three patients required additional coverage. There was no significant difference in flap complications between the extended and nonextended flap designs. Independent ambulation was achieved in 82 percent of patients. CONCLUSIONS: The vertical and extended RAM flaps provide reliable coverage of irradiated thigh and groin oncologic wounds, with significantly improved results obtained with immediate versus delayed reconstruction.

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