Large Perineal Defect Covered by VRAM Flap after Abdominoperineal Resection: A Surgical Solution for Wound Management

Abstract

The management of extensive perineal defects resulting from aggressive tumor resections, such as abdominoperineal resections for advanced pelvic malignancies, can be a complex and demanding process in the treatment journey. The primary options for reconstructing perineal defects are vertical rectus abdominis myocutaneous (VRAM) and anterolateral thigh (ALT) flaps. While both flaps are commonly used in reconstructive surgery, VRAM is often preferred due to several advantages. These include the ability to provide ample tissue to fill large perineal defects, as well as the convenience of harvesting this type of flap through a midline incision. This approach allows for a more cosmetically favorable scar location compared to other techniques. Overall, VRAM is a superior choice for perineal reconstruction due to its versatility and effectiveness in addressing complex defects. In this article, we describe our experience with utilizing a vertical rectus abdominis myocutaneous flap to close a 20 x 10 cm perineal defect that arose after an abdominoperineal resection performed due to extensive rectal melanoma in a 46-year-old male. We found that the vertical rectus abdominis myocutaneous flap was an exceptional choice for covering this substantial defect in our case.

Keywords

• perineal defect
• vertical rectus abdominis myocutaneous flap
• reconstructive surgery