title: A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration.
abstract: OBJECTIVE
  We analysed the outcomes of a series of 100 consecutive patients with anorectal cancer with neoadjuvant radiochemotherapy and abdominoperineal exstirpation or total pelvic exenteration, who received a transpelvic vertical rectus abdominis myocutaneous (VRAM) flap for pelvic, vaginal and/or perineal reconstruction and compare a cohort to patients without VRAM flaps.
  
  
  METHODS
  Within a 10-year period (2003-2013) in our institution 924 patients with rectal cancer stage y0 to y IV were surgically treated. Data of those 100 consecutive patients who received a transpelvic VRAM flap were collected and compared to patients without flaps.
  
  
  RESULTS
  In 100 consecutive patients with transpelvic VRAM flaps, major donor site complications occurred in 6 %, VRAM-specific perineal wound complications were observed in 11 % of the patients and overall 30-day mortality was 2 %.
  
  
  CONCLUSIONS
  The VRAM flap is a reliable and safe method for pelvic reconstruction in patients with advanced disease requiring pelvic exenteration and irradiation, with a relatively low rate of donor and recipient site complications. In this first study, to compare a large number of patients with VRAM flap reconstruction to patients without pelvic VRAM flap reconstruction, a clear advantage of simultaneous pelvic reconstruction is demonstrated.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich Alexander University Erlangen-Nuernberg, Krankenhausstrasse 12, 91054, Erlangen, Germany, Raymund.horch@uk-erlangen.de.
authors.forename: R E
authors.initials: RE
authors.lastname: Horch
authors.forename: W
authors.initials: W
authors.lastname: Hohenberger
authors.forename: A
authors.initials: A
authors.lastname: Eweida
authors.forename: U
authors.initials: U
authors.lastname: Kneser
authors.forename: K
authors.initials: K
authors.lastname: Weber
authors.forename: A
authors.initials: A
authors.lastname: Arkudas
authors.forename: S
authors.initials: S
authors.lastname: Merkel
authors.forename: J
authors.initials: J
authors.lastname: Göhl
authors.forename: J P
authors.initials: JP
authors.lastname: Beier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000601:surgery; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap; D020360:Neoadjuvant Therapy; D010385:Pelvic Exenteration; D010386:Pelvic Neoplasms / Q000601:surgery*; D010388:Pelvis / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
references.citation: N Engl J Med. 2004 Oct 21;351(17):1731-40
references.pmid: 15496622
references.citation: Dis Colon Rectum. 2001 Feb;44(2):173-8
references.pmid: 11227932
references.citation: Cancer. 1998 Aug 1;83(3):510-20
references.pmid: 9690544
references.citation: Ann Plast Surg. 2013 Jul;71(1):96-102
references.pmid: 22791061
references.citation: World J Surg. 2011 Sep;35(9):2134-42
references.pmid: 21607819
references.citation: Dis Colon Rectum. 2009 Apr;52(4):662-8
references.pmid: 19404072
references.citation: Br J Surg. 2005 Apr;92(4):482-6
references.pmid: 15736219
references.citation: J Natl Cancer Inst. 2000 Mar 1;92(5):388-96
references.pmid: 10699069
references.citation: Ann Surg. 2013 Dec;258(6):1007-13
references.pmid: 23364701
references.citation: Ann Surg. 2010 May;251(5):807-18
references.pmid: 20395841
references.citation: Am J Clin Oncol. 2005 Jun;28(3):227-33
references.pmid: 15923793
references.citation: Dis Colon Rectum. 2013 Jan;56(1):14-9
references.pmid: 23222275
references.citation: Dis Colon Rectum. 2000 Mar;43(3):312-9
references.pmid: 10733111
references.citation: Surgery. 2001 Oct;130(4):767-72; discussion 772-3
references.pmid: 11602910
references.citation: Colorectal Dis. 2011 Jul;13(7):732-42
references.pmid: 20041928
references.citation: J Cell Mol Med. 2011 Jul;15(7):1564-71
references.pmid: 20716124
references.citation: Arch Orthop Trauma Surg. 2011 Jun;131(6):849-55
references.pmid: 21188393
references.citation: Ann Plast Surg. 2004 Jan;52(1):22-6
references.pmid: 14676694
references.citation: Ann Plast Surg. 1997 Feb;38(2):115-22; discussion 122-3
references.pmid: 9043579
references.citation: Urology. 2002 Sep;60(3):502-7
references.pmid: 12350497
references.citation: Plast Reconstr Surg. 2011 Aug;128(2):447-458
references.pmid: 21788836
references.citation: Ann Surg. 2009 Nov;250(5):707-11
references.pmid: 19801930
references.citation: Arch Orthop Trauma Surg. 2012 May;132(5):655-61
references.pmid: 22246464
references.citation: Singapore Med J. 1999 Oct;40(10):654-5
references.pmid: 10741195
references.citation: Br J Surg. 2003 May;90(5):575-80
references.pmid: 12734865
references.citation: J Cell Mol Med. 2012 Jun;16(6):1157-65
references.pmid: 22436120
references.citation: Plast Reconstr Surg. 2010 Jul;126(1):146-155
references.pmid: 20220559
references.citation: Cancer. 1993 Jun 15;71(12 Suppl):4267-77
references.pmid: 8508389
references.citation: Ann Surg Oncol. 1995 Sep;2(5):400-6
references.pmid: 7496834
references.citation: Eur J Gynaecol Oncol. 2010;31(2):201-5
references.pmid: 20527241
references.citation: Colorectal Dis. 2012 Sep;14(9):1076-83
references.pmid: 22107085
references.citation: J Plast Reconstr Aesthet Surg. 2012 Dec;65(12):1734-7
references.pmid: 22652285
references.citation: Acta Oncol. 2008;47(6):994-1003
references.pmid: 18607875
references.citation: Eur J Cancer. 2013 Jan;49(1):90-7
references.pmid: 22926014
references.citation: Colorectal Dis. 2013 Jan;15(1):47-51
references.pmid: 22642835
references.citation: Int J Colorectal Dis. 2013 Jun;28(6):801-6
references.pmid: 23053678
references.citation: Indian J Cancer. 2001 Mar;38(1):33-7
references.pmid: 14758883
references.citation: Colorectal Dis. 2006 Jan;8(1):23-33
references.pmid: 16519634
references.citation: Ann Surg Oncol. 2009 Jan;16(1):68-77
references.pmid: 18985271
references.citation: J Cell Mol Med. 2011 Apr;15(4):983-93
references.pmid: 20345846
references.citation: J Plast Reconstr Aesthet Surg. 2012 Apr;65(4):521-4
references.pmid: 21873132
references.citation: Eur J Surg Oncol. 2005 Dec;31(10):1185-90
references.pmid: 16126359
references.citation: Am J Surg. 2013 Jan;205(1):64-70
references.pmid: 22854008
references.citation: J R Soc Med. 1989 Jun;82(6):369-70
references.pmid: 2810322
references.citation: J Gastrointest Surg. 2001 Jul-Aug;5(4):383-7
references.pmid: 11985979
references.citation: G Chir. 1998 May;19(5):197-8
references.pmid: 9677768
references.citation: Int J Colorectal Dis. 2009 Jan;24(1):97-104
references.pmid: 18688618
references.citation: Int J Colorectal Dis. 2012 Apr;27(4):475-82
references.pmid: 22006494
references.citation: Ann R Coll Surg Engl. 1995 May;77(3):229-32
references.pmid: 7598425
references.citation: Int J Colorectal Dis. 2013 Feb;28(2):197-206
references.pmid: 23143162
references.citation: Lancet Oncol. 2012 Jul;13(7):679-87
references.pmid: 22627104
references.citation: Dis Colon Rectum. 2008 Aug;51(8):1237-41
references.pmid: 18481146
references.citation: J Surg Oncol. 2010 Sep 1;102(3):287-94
references.pmid: 20740589
references.citation: Chirurg. 2009 May;80(5):462, 464-5
references.pmid: 18854962
references.citation: Plast Reconstr Surg. 2012 Aug;130(2):265e-273e
references.pmid: 22842423
references.citation: Ann R Coll Surg Engl. 2011 Jul;93(5):375-81
references.pmid: 21943461
references.citation: Ann Plast Surg. 1984 Jul;13(1):56-9
references.pmid: 6234839
references.citation: Surg Today. 2003;33(8):626-9
references.pmid: 12924422
references.citation: Plast Reconstr Surg. 2009 Jan;123(1):175-183
references.pmid: 19116551
references.citation: Magy Seb. 2012 Oct;65(5):388-95
references.pmid: 23086826
references.citation: Colorectal Dis. 2009 May;11(4):354-64; discussion 364-5
references.pmid: 19016817
references.citation: Colorectal Dis. 2010 Jun;12(6):555-60
references.pmid: 19341404
references.citation: Chirurg. 2011 Jul;82(7):625-30
references.pmid: 21161142
references.citation: Plast Reconstr Surg. 2009 Oct;124(4):1177-1185
references.pmid: 19935301
references.citation: Ann Plast Surg. 2003 Dec;51(6):556-60
references.pmid: 14646647
references.citation: Plast Reconstr Surg. 1994 Feb;93(2):324-7; discussion 328-9
references.pmid: 8310024
references.citation: J Plast Reconstr Aesthet Surg. 2012 Jun;65(6):791-7
references.pmid: 22264638
references.citation: Am Surg. 2009 Oct;75(10):995-9
references.pmid: 19886152
references.citation: Clin Plast Surg. 1990 Oct;17(4):705-12
references.pmid: 2249391
references.citation: J Cell Mol Med. 2012 Oct;16(10):2350-61
references.pmid: 22304383
references.citation: Int J Radiat Oncol Biol Phys. 1998 Jan 15;40(2):427-35
references.pmid: 9457832
references.citation: J Cell Mol Med. 2011 Jun;15(6):1364-78
references.pmid: 20636333
references.citation: J Cell Mol Med. 2011 Jul;15(7):1582-92
references.pmid: 20716116
references.citation: J Plast Reconstr Aesthet Surg. 2010 Feb;63(2):e127-9
references.pmid: 19631598
references.citation: J Am Coll Surg. 2008 Apr;206(4):694-703
references.pmid: 18387476
references.citation: Colorectal Dis. 2001 May;3(3):154-60
references.pmid: 12790981
references.citation: Plast Reconstr Surg. 2010 Nov;126(5):1573-1580
references.pmid: 20639803
references.citation: Ann Surg. 2013 Jun;257(6):e16
references.pmid: 23665972
references.citation: World J Surg. 2000 Jun;24(6):747-51; discussion 752
references.pmid: 10773130
references.citation: Plast Reconstr Surg. 1992 Jan;89(1):90-5
references.pmid: 1727268
references.citation: Colorectal Dis. 2010 Nov;12(11):1094-8
references.pmid: 19863609
references.citation: Colorectal Dis. 2009 Oct;11(8):806-16
references.pmid: 19055518
references.citation: Chirurg. 2007 Aug;78(8):739-47
references.pmid: 17569018
references.citation: Dis Colon Rectum. 2011 Jun;54(6):711-7
references.pmid: 21552056
references.citation: Br J Surg. 2010 Apr;97(4):588-99
references.pmid: 20186891
references.citation: Plast Reconstr Surg. 2011 Jan;127(1):200-209
references.pmid: 21200212
references.citation: Arch Surg. 2003 Dec;138(12):1340-3
references.pmid: 14662535
references.citation: Int J Colorectal Dis. 2005 Sep;20(5):446-51
references.pmid: 15843939
references.citation: Int J Gynecol Cancer. 2010 Dec;20(9):1609-12
references.pmid: 21119371
references.citation: Can J Surg. 2010 Apr;53(2):137-42
references.pmid: 20334747
references.citation: Dis Colon Rectum. 2009 Dec;52(12):1962-6
references.pmid: 19934916
references.citation: Aust N Z J Surg. 1976 Aug;46(3):197-201
references.pmid: 1070292
references.citation: Ann Surg. 2012 May;255(5):922-8
references.pmid: 22504191
references.citation: Chirurg. 2009 Apr;80(4):294-302
references.pmid: 19350306
references.citation: Hernia. 2007 Dec;11(6):541-5
references.pmid: 17503160
references.citation: Am Surg. 1989 Oct;55(10):632-7
references.pmid: 2529805
references.citation: Arch Surg. 1990 Jul;125(7):911-3
references.pmid: 1695088
references.citation: Lancet Oncol. 2003 Mar;4(3):158-66
references.pmid: 12623361
references.citation: Ann Gastroenterol Hepatol (Paris). 1986 Nov;22(6):361-3
references.pmid: 3813478
references.citation: Ann R Coll Surg Engl. 1984 Sep;66(5):337-9
references.pmid: 6237602
references.citation: J Clin Oncol. 2012 Jun 1;30(16):1926-33
references.pmid: 22529255
references.citation: Surgery. 2010 Mar;147(3):339-51
references.pmid: 20004450
references.citation: Langenbecks Arch Surg. 2011 Dec;396(8):1271-9
references.pmid: 21779830
references.citation: Oncology. 2000;58(1):31-7
references.pmid: 10644938
references.citation: Eur J Surg Oncol. 2004 Apr;30(3):260-5
references.pmid: 15028306
references.citation: Colorectal Dis. 2003 May;5(3):214-7
references.pmid: 12780880
references.citation: Colorectal Dis. 2003 Sep;5(5):436-41
references.pmid: 12925076
references.citation: J Clin Oncol. 2012 May 20;30(15):1763-9
references.pmid: 22473170
references.citation: Int J Gynecol Cancer. 2005 May-Jun;15(3):542-8
references.pmid: 15882183
references.citation: J Cell Mol Med. 2011 Nov;15(11):2452-61
references.pmid: 21199325
references.citation: Colorectal Dis. 2011 Feb;13(2):123-31
references.pmid: 19895596
references.citation: Ann Surg Oncol. 2012 Feb;19(2):502-3
references.pmid: 21826560