Perineal reconstruction using pedicled vertical rectus abdominis myocutaneous flap (VRAM).

BACKGROUND: The perineal wound is a major source of morbidity after abdominoperineal resection (APR) for rectal cancer, particularly after preoperative irradiation. Myocutaneous flap reconstruction is a viable alternative to primary perineal wound repair providing well-vascularized non-irradiated tissue to fill the dead space, and improve wound healing.

PATIENTS AND METHODS: Sixty patients with low rectal cancer receiving neoadjuvant radiotherapy were prospectively randomized to either primary perineal wound closure (Group B) or VRAM perineal reconstruction (Group A). The study was carried out in the surgical department, National Cancer Institute (NCI), Cairo University over a period of 4 years from August 2008 to July 2012. All patients were evaluated as regards incidence of perineal wound complications, abdominal wall complications, and added co-morbidity.

RESULTS: Perineal wound complications were observed in 5 patients in group A (17.2%) and in 14 patients in group B (46.4%) (P = 0.015). There was no significant difference in the incidence of abdominal wound morbidity between both groups. Operative blood loss and time were lower in group B.

CONCLUSION: The vertical rectus myocutaneous flap (VRAM) is a relatively simple and reliable technique for perineal wound reconstruction after abdominoperineal resection.