Vertical Rectus Abdominis Musculocutaneous Research Articles

Viability of the vertical rectus abdominis musculocutaneous flap in the rat following prior internal mammary artery ligation

A large abdominal skin flap nourished superiorly by a single rectus abdominis muscle has well known advantages for providing vascularized tissue coverage of thoracic defects. Unfortunately, if both internal mammary arteries have previously been violated, as is increasingly common today following coronary artery revascularization, initial consideration of this flap would seem to be contraindicated. Nevertheless, anecdotal examples of clinical survival of the rectus abdominis muscle flap in this situation exist. This laboratory study was initiated to ascertain whether a musculocutaneous flap could also be expected to survive. Using a Sprague-Dawley rat model, identical bilateral vertical rectus abdominis musculocutaneous (VRAM) flaps were designed. The internal thoracic [sic. mammary] vessels supplying one muscle had been divided two weeks previously just above the costal margin, as frequently encountered in the clinical situation. Mean survival of control flaps (intact internal thoracic) was 85.5±5.9% versus 67.9±35.3% for the delayed flap that relied on collateral circulation for any viability. Although no statistical difference per se existed between these groups (p=0.32), the great variability in surviving portions of those flaps dependent only on available collaterals suggests extreme caution before assuming that any abdominal skin flap based on a rectus abdominis muscle without an intact internal mammary source vessel would be reliable.

Total scrotal reconstruction with vertical rectus abdominis musculocutaneous (VRAM) flap in the treatment of penoscrotal lymphedema

A 37-year-old man with scrotal and penile lymphedema was treated by total excision of the scrotal and penile skin and subcutaneous tissue. Split thickness skin grafts were used to cover the penis and the pubic area. An inferiorly based left rectus abdominis muscle with a 12 x 16 cm skin island from the epigastric region was used to reconstruct the scrotum. The VRAM flap is a simple, reliable flap and it provides sufficient coverage of the exposed testicles after total excision of diseased scrotal skin. It also gives a satisfactory esthetic result. The VRAM flap may be another source for reconstruction of the total scrotum.