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Component Separation Improves Outcomes in VRAM Flap Donor Sites with Excessive Fascial Tension

Baumann, Donald P. M.D.; Butler, Charles E. M.D.

Plastic & Reconstructive Surgery: November 2010 - Volume 126 - Issue 5 - pp 1573-1580
doi: 10.1097/PRS.0b013e3181ef8d00
Reconstructive: Trunk: Original Articles
Advanced

Background: The vertical rectus abdominis musculocutaneous (VRAM) flap has numerous uses in pelvic reconstruction; however, flap harvest can result in abdominal wall morbidity. The authors hypothesized that combining component separation with fascial advancement closure would result in acceptable surgical donor-site outcomes.

Methods: Patients were evaluated who underwent VRAM flap reconstruction for contaminated pelvic defects and component separation with fascial advancement closure or tension-bearing primary fascial closure for VRAM flap donor-site defects between 2006 and 2009. The indication for component separation was the inability to approximate fascial edges (1) at all or (2) without excessive fascial tension, creating a high risk of postoperative failure. Primary outcome indicators included wound complications, myofascial laxity, and incisional hernia.

Results: Seventy-four patients were included in the study: 15 who underwent component separation and 59 who underwent primary fascial closure. The mean follow-up was 16 months (range, 6 to 39 months). The incidences of seroma, infection, and skin and fascial dehiscence were higher in the primary fascial closure group (39 percent) than in the component separation group (13 percent) (p < 0.053). There was a fourfold greater incidence of incisional hernia in the primary fascial closure group (24 percent) than in the component separation group (6 percent). There was also a trend toward a higher incidence of myofascial laxity in the primary fascial closure group (14 percent) than in the component separation group (6 percent).

Conclusions: Component separation was effective in allowing closure of VRAM donor sites that were otherwise impossible to reapproximate without excessive fascial tension. Component separation closures resulted in fewer postoperative wound complications, hernias, and bulges, despite a more difficult closure, and should be considered when fascial closure tension would be excessive.

CODING PERSPECTIVE FOR THIS ARTICLE IS ON PAGE 1579.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication March 30, 2010; accepted May 7, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Charles E. Butler, M.D., Department of Plastic Surgery, Unit 443, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, cbutler@mdanderson.org

©2010American Society of Plastic Surgeons