Modified vertical rectus abdominis musculocutaneous flap for limb salvage procedures in proximal lower limb musculoskeletal sarcomas

Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps

BACKGROUND/AIM

Resection of tumors from the groin and thigh regions with safe margins often results in significant soft tissue defects, which preclude primary closure. This study presents a series of rectus abdominis myocutaneous flaps for irradiated thigh and groin wounds with the purpose of evaluating the efficacy and outcomes of these flaps in this population.

MATERIALS AND METHODS

From 2008 to 2015, all patients who underwent resection of thigh or groin region tumors and reconstruction with an inferiorly based rectus abdominis myocutaneous flap were retrospectively identified. Medical records of the patients were reviewed.

RESULTS

A total of 27 patients, aged 20-67 years, were operated on for defects in the groin and upper thigh region. Nine patients underwent immediate reconstruction. The remaining 18 patients underwent late reconstruction. There was neither total flap loss nor partial flap loss. We chose to utilize 15 ipsilateral and 12 contralateral pedicles. The mean length of stay in hospital was 13.7 days.

CONCLUSION

A rectus abdominis myocutaneous flap can be successfully used in patients with groin and upper thigh defects due to its predictable and robust vascular supply, bulky muscle content, wide arc of rotation, and large skin island.

Evaluation of Flap Tissue Viability by F-18 FDG PET/CT

A 60-year-old man underwent vertical rectus abdominis myocutaneous flap to reconstruct a left lateral chest wall defect. For assessment of viability of muscle flap, F-18 fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed 15 days after surgery. The FDG PET/CT showed a small metabolic defect in the left lateral chest wall. During follow-up, necrotic change of the graft was observed, and the site was in accordance with the area where the metabolic defect was observed in the FDG PET/CT. As a result, debridement and wound closure was performed. This case suggested that the FDG PET/CT should be a useful method for the monitoring of muscle viability after flap surgery.

Management of infected femoral artery pseudoaneurysm repair: rectus abdominis flap as second-line management after sartorius flap failure

BACKGROUND

The incidence of infected femoral artery pseudoaneurysms is likely to increase with increasing numbers of femoral artery interventions.

METHODS

Case report and review of literature.

RESULTS

We present a case of dehiscence of a vein patch repair of an infected femoral pseutoaneurysm treated with ligation of vessels and coverage by rectus abdominis muscle flap.

CONCLUSION

We consider the use of this flap as a good second line option for the coverage of exposed femoral vessels, in the presence of sepsis, particularly when the external iliac artery has been ligated.

Use of adjuvant techniques improves surgical outcomes of complex vertical rectus abdominis myocutaneous flap reconstructions of pelvic cancer defects

BACKGROUND

Reconstruction of irradiated pelvic defects following oncologic resection requires dead-space obliteration to reduce wound healing complications. Although the vertical rectus abdominis myocutaneous (VRAM) flap is often the best option for pelvic reconstruction following abdominoperineal resection or pelvic exenteration, donor- and recipient-site complications are common. The authors hypothesized that certain adjuvant techniques would improve pelvic VRAM flap outcomes.

METHODS

Six technical modifications to improve VRAM flap outcomes were evaluated: fascia-sparing VRAM flap, component separation donor-site closure, inlay mesh abdominal reinforcement, deepithelialized VRAM flap skin paddle, extended VRAM flap, and omental flap plus VRAM flap. Prospectively collected data from consecutive patients with immediate pelvic VRAM flap reconstruction from 2001 to 2009 were analyzed retrospectively. Donor- and recipient-site complications were compared between patients treated with each technical modification and all other study patients.

RESULTS

One hundred eighty-five patients were included (mean follow-up, 25.1 months). Fascia-sparing VRAM flaps resulted in significantly fewer hernias (1.5 percent versus 11.5 percent, p < 0.01), with less dehiscence, abdominal bulge, and evisceration. Patients receiving donor-site mesh inlay had fewer postoperative hernias (2.6 percent versus 5.5 percent) but more abdominal laxity/bulge (7.7 percent versus 0 percent, p = 0.01). Minor recipient-site dehiscence was significantly lower with omental plus VRAM flaps (11.1 percent versus 32.5 percent, p < 0.05) and extended VRAM flaps (7.7 percent versus 30.8 percent, p < 0.05). Multivariate logistic regression identified omental plus VRAM flaps as protective against (p < 0.05), and increasing body mass index as predictive for (p = 0.009), perineal skin dehiscence.

CONCLUSIONS

Several technical modifications of VRAM flap reconstruction improve pelvic reconstruction outcomes and should be considered. Further prospective studies will be important to elucidate specific indications for each technique.

The management of soft tissue sarcoma

SUMMARY

Soft tissue sarcomas are a rare group of mesenchymal tumours that display cardinal signs, which can raise suspicion to their diagnosis. Management in a sarcoma treatment centre by its multidisciplinary team has improved outcome. Good local disease control with limb salvage and adjuvant radiotherapy has considerably reduced the morbidity of previous limb amputation. By the early involvement of a plastic surgeon, tissue reconstruction is optimised and wound complications reduced. This article looks at the contemporary management of soft tissue sarcoma and, in particular, its relevance to the plastic surgeon today.