title: The oblique rectus abdominal myocutaneous flap for complex pelvic wound reconstruction.
abstract: OBJECTIVE
  The oblique rectus abdominal myocutaneous flap is a seldom used flap design based on perforating vessels exiting the rectus near the umbilicus. Compared to other flaps, the oblique rectus abdominal myocutaneous flap provides increased soft tissue to fill pelvic dead space, with the further advantage of intact skin to close perineal defects. Here we detail the oblique rectus abdominal myocutaneous flap in achieving closure of complex perineal wounds.
  
  
  METHODS
  A review of indications and outcomes in 16 patients undergoing complex pelvic operations requiring reconstruction with this flap was undertaken.
  
  
  RESULTS
  All patients had been previously treated with pelvic irradiation for cancer. Indications for flap reconstruction included abdominal perineal resection for anal/rectal cancer, pelvic sarcoma/sacral resection/exenteration, small bowel/colonic fistula resection, and total proctocolectomy with vaginal reconstruction. Median follow-up was 17 (range, 1-57) months. Complications included epidermal necrosis at the flap tip (n = 2), delayed perineal wound breakdown (n = 1), one abdominal wound infection, one small abdominal dehiscence, and four pelvic abscesses all managed nonoperatively. A single recurrent fistula required operative resection three months postoperatively. There were no cases of complete flap necrosis, vascular failure or persistently draining perineal sinus, and no mortalities related to the flap reconstruction.
  
  
  CONCLUSIONS
  The treatment of complex pelvic wounds, especially following pelvic radiation, is facilitated by the oblique rectus abdominal myocutaneous flap. This technique provides ample tissue for large pelvic wounds, including skin for perineal defects. Comparing our results to existing literature, the oblique rectus abdominal myocutaneous flap displays a favorable morbidity profile, providing a safe means of delivering well-vascularized tissue to the pelvic cavity and perineal floor.
authors.affiliation: Department of Surgery, Northwestern University, Feinberg School of Medicine, 201 E. Huron, Chicago, Illinois 60611, USA, abbottdan@sbcglobal.net
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Amy L
authors.initials: AL
authors.lastname: Halverson
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Wayne
authors.forename: John Y S
authors.initials: JY
authors.lastname: Kim
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery