Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

• Published in: Colorectal disease 2020-05, Vol.22 (5), p.562-568
• Main Authors: Proctor, M. J., Westwood, D. A., Donahoe, S., Chauhan, A., Lynch, A. C., Heriot, A. G., Sent‐Doux, K., Creagh, T., Frizelle, F. A., Wakeman, C. J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; flap; Health risk assessment; Humans; Male; Middle Aged; Morbidity; Myocutaneous Flap - transplantation; Patients; Perineum - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Radiation therapy; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Rectus Abdominis - transplantation; Retrospective Studies; Smoking; Surgery; vertical rectus abdominis myocutaneous (VRAM); Wound healing
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.14909

Aim Patients who undergo radical pelvic surgery often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of vertical rectus abdominus myocutaneous (VRAM) flaps due to the balance between primary healing and the complications associated with this form of reconstruction. This study aimed to evaluate factors associated with significant flap and donor site related complications following VRAM flap reconstruction for radical pelvic surgery. Method A retrospective analysis of VRAM flap related complications was undertaken from prospectively maintained databases for all patients undergoing radical pelvic surgery (2001– 2017) in two cancer centres. Results In all, 154 patients were identified [median age 62 years (range 26–89 years), 80 (52%) men]. Thirty‐three (21%) patients experienced significant donor or flap related complications. Major complications (Clavien–Dindo ≥ 3) related to the abdominal donor site occurred in nine (6%) patients, while those related to the flap or perineal site occurred in 28 (18%) patients. Only smoking (P = 0.003) and neoadjuvant radiotherapy (P = 0.047) were associated with the development of significant flap related complications on univariate analysis. Flap related complications resulted in a significantly longer hospital stay (P