title: Vertical rectus abdominis musculocutaneous flow-through flap to a free fibula flap for total sacrectomy reconstruction.
abstract: OBJECTIVE
  The purpose of this report of a small series was to describe the technique of total sacrectomy reconstruction using a pedicled vertical rectus abdominis musculocutaneous (VRAM) flow-through flap anastomosed to a free fibula flap.
  
  
  METHODS
  We reviewed all consecutive total sacrectomy reconstructions performed from 2009 to 2011. Surgical technique and patient outcomes were assessed.
  
  
  RESULTS
  Total sacrectomy reconstructions included three two-stage and three-stage VRAM flow-through flap to free fibula flap patients all of which ambulated by discharge. Flap survival was 100%. Pelvic ring defects were reconstructed with A-frame fibula flap struts anastomosed to the distal epigastric vessels of pedicled trans-pelvic VRAM flaps. Complications such as wound healing, infection or hardware failure were not observed. Bony union occurred at an average 2.7 ± 0.6 months.
  
  
  CONCLUSIONS
  Total sacrectomy reconstruction using a VRAM flow-through flap anastomosed to a two-strut free fibular flap allows initial assessment of the recipient vessels during the first and ensuing operative stages, satisfies the bone and soft tissue requirements of the defect, and provides a durable, functionally optimized reconstruction.
authors.affiliation: Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA. pbgarvey@mdanderson.org
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Garvey
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002817:Chordoma / Q000601:surgery; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome