Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

Haitham H Khalil,Walid Ebeid,Ahmed Afifi,Ahmed El-Ghoneimy,Yasser Farid,Tarek Mahboub,Ahmed Elaffandi

doi:10.1155/2008/781408

Abstract

Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases). Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

Highlights

Introduction and aimManagement of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients
The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas
Radical oncological salvage procedures performed in this area can develop significant wound complications that result from a high incidence of infection, dehiscence, or flap necrosis aggravated by the paucity of well-vascularized local soft tissue and systemically immunecompromised patients [3,4,5,6]

Summary

Introduction

Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site. The reconstruction of extensive and complex wounds as a secondary event after tumor extipiration represents a challenging problem for both the orthopaedic and reconstructive surgeons [7] This would thereby jeopardize the long-term wound healing with delay in the postoperative adjuvant chemotherapy and eventually the successful outcome. The authors present two modifications of the standard VRAM flap for coverage of extensive potentially infected defects after radical debridement of complicated groin and upper thigh wounds. The modifications included an inferiorly based VRAM flap with lateral and tongue-like extension design of the skin paddle or a delayed extended VRAM flap

Methods

Results

Conclusion