Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects

BACKGROUND: Reconstruction following abdominoperineal resection or pelvic exenteration is commonly performed with regional flaps from the thigh or abdomen. This study compared the surgical outcomes and complications in cancer patients who underwent immediate reconstruction of these defects with vertical rectus abdominis myocutaneous (VRAM) versus thigh flaps. METHODS: One hundred thirty-three patients who underwent abdominoperineal resection or pelvic exenteration for cancer resection and immediate VRAM (n = 114) or thigh flap (n = 19) reconstruction of the perineal/pelvic defect were studied. Patient, tumor, and treatment characteristics; surgical outcomes; and postoperative donor- and recipient-site complications were compared between the two groups. Multivariate logistic regression analysis was used to identify predictive/protective factors for complications. RESULTS: The thigh flap group had a significantly greater incidence of major complications (42 percent versus 15 percent) than the VRAM flap group. They also had significantly higher rates of donor-site cellulitis (26 percent versus 6 percent) and recipient-site complications, including cellulitis (21 percent versus 4 percent), pelvic abscess (32 percent versus 6 percent), and major wound dehiscence (21 percent versus 5 percent). Abdominal wall complications were not increased in the VRAM group despite flap harvest from the abdominal wall. Obesity was an independent predictor of any donor-site complication (odds ratio, 3.3) and previous abdominal surgery was a predictor of any complication (odds ratio, 3.6), any recipient-site complication (odds ratio, 3.5), and any major complication (odds ratio, 3.6). CONCLUSION: Immediate VRAM flaps result in fewer major complications than thigh flaps without increased early abdominal wall morbidity when used to repair abdominoperineal resection and pelvic exenteration defects.