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Reconstruction of extensive defects with combined transverse-vertical rectus abdominis (cruciate) myocutaneous flaps
Coriddi M, MD; Miller M, MD; Chao A, MD
Ohio State University
2013-03-15
Presenter: Coriddi
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Limited options exist for the reconstruction of extensive defects with a single flap, and include subtotal thigh and fillet flaps. Flaps based on the rectus abdominis system, such as transverse(TRAM) and vertical rectus abdominis myocutaneous (VRAM) flaps, are reliable, but their size can be limited by patient body habitus and consideration of donor site closure. Here we describe our experience with combined TRAM-VRAM (cruciate) flaps, which can be used to reconstruct large defects while allowing for primary donor site closure.
Methods: A retrospective review of all patients who underwent reconstruction with a combined TRAM-VRAM flap between 2007 and 2012 was performed.
Results: A total of 4 patients underwent reconstruction with a combined TRAM-VRAM flap. Once case involved a pedicled flap, which was used for chest wall reconstruction in a thin patient with metastatic cancer and sternal osteoradionecrosis. Three cases involved free flaps, including for obliteration of radiated intrathoracic dead space in a patient with post-pneumonectomy bronchopleural fistula, pediatric lower extremity reconstruction, and chest wall reconstruction in a patient with extensive burns. There were no flap losses. In all patients, primary donor site closure was performed without wound breakdown, hernia, or bulge.
Conclusion: The combined TRAM-VRAM flap is a useful modification of flaps based off the rectus abdominis system. It may be performed as either pedicled or free flap for the reconstruction of extensive defects, while allowing for primary donor site closure with little associated donor site morbidity. Details of flap design are discussed, including maximizing perfusion to this large flap.
