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The Vertical and Extended Rectus Abdominis Myocutaneous Flap for Irradiated Thigh and Groin Defects

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

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 171-177
doi: 10.1097/PRS.0b013e3181774330
Reconstructive: Lower Extremity: Original Articles

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.

Boston, Mass.

From the Division of Plastic Surgery and the Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School.

Received for publication July 23, 2007; accepted October 1, 2007.

William G. Austen, Jr., M.D.; Plastic and Reconstructive Surgery; Massachusetts General Hospital; Wang Building; ACC-435, 15 Parkman Street; Boston, Mass. 02114;

Disclosure: None of the authors has any commercial associations or financial disclosures to report.

©2008American Society of Plastic Surgeons