Use of the Vertical Rectus Abdominis Muscle Flap for an Open Pelvic Fracture Secondary to a Blast Injury: A Case Report.

Abstract

Open pelvic fractures as a result of high-energy blasts are relatively uncommon, and, to our knowledge, management of these injuries has not been previously described in the literature. Complex open fractures of the pelvis benefit from a multidisciplinary approach that can minimize morbidity1,2. The high complication rate associated with these injuries is usually the result of local wound contamination and lack of soft-tissue coverage. Depending on the severity of the open injury, options for tissue coverage include delayed primary closure, skin-grafting, a pedicled flap, or a free flap3-5. The vertical rectus abdominis muscle (VRAM) flap has historically been utilized for the surgical reconstruction of large pelvic or perineal defects associated with the resection of gastrointestinal, gynecological, and urologic neoplasms4,6-9. Reports of its use in the setting of traumatic wounds are limited. In this case report, we present the use of a pedicled VRAM flap for definitive coverage of an open pelvic fracture with substantial soft-tissue loss as a result of a blast injury. Our review of the literature revealed no reports of the VRAM flap utilized in this context. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old man on active duty sustained a blast injury after a C-4 explosion during a military training exercise. Injuries included an open left iliac crest fracture, a left comminuted ischial wing fracture, a left sacroiliac fracture, and an open fracture of the proximal part of the left ulna. Initial evaluation and computed tomographic (CT) imaging studies obtained on the day of injury confirmed the left iliac wing fracture 10 mm superior to the acetabulum, coupled with a 35 × 15-cm soft-tissue defect of the pelvis and thigh with …