title: Modified vertical rectus abdominis myocutaneous flap vaginal reconstruction: an analysis of surgical outcomes.
abstract: OBJECTIVE
  To examine the early and late flap related morbidity and associated risk factors in patients with modified vertical rectus abdominis myocutaneous (VRAM) flap neovaginal reconstruction at the time of pelvic exenteration for gynecologic malignancy.
  
  
  METHODS
  From January 1993 to January 2011, all patients were identified who underwent anterior, posterior, or total pelvic exenteration with VRAM flap neovaginal reconstruction. Patient records were systematically reviewed and demographic, clinicopathologic, operative details, flap related complications, and risk factors for wound healing were recorded and statistical analysis performed.
  
  
  RESULTS
  46 patients were identified who underwent exenteration with VRAM flap vaginal reconstruction. A risk factor for poor healing including obesity, diabetes, smoking, prior radiation, previous abdominal surgery, or poor nutritional status was present in 38 (82.6%) patients, and 24 (52.2%) had two or more risk factors. Flap complications occurred in 9 (19.6%) patients, one with complete flap necrosis that required re-operation, two with superficial flap necrosis, and three with superficial flap separation. Three patients (6.5%) suffered from vaginal stenosis, one of which was complete. Anterior abdominal wound separation occurred in 22 (47.8%) patients and pelvic abscess occurred in 14 (30.4%) patients. No individual risk factor was significantly associated with VRAM flap related morbidity; however obesity, prior radiation, and prior abdominal incision were present in nearly all the patients with flap complications.
  
  
  CONCLUSIONS
  This series confirms that modified VRAM flaps can be used successfully at the time of exenteration, even in an increasingly high risk patient population with an acceptable risk for flap complications.
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Berger
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.forename: Bryan
authors.initials: B
authors.lastname: Fellman
authors.forename: Vijayashri
authors.initials: V
authors.lastname: Rallapali
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010385:Pelvic Exenteration; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*