title: Contralateral Component Separation Technique for Abdominal Wall Closure in Patients Undergoing Vertical Rectus Abdominis Myocutaneous Flap Transposition for Pelvic Exenteration Reconstruction.
abstract: Pelvic floor reconstruction with pedicled vertical rectus abdominis myocutaneous flap has been popularized in patients undergoing pelvic exenteration due to locally advanced rectal carcinoma. Abdominal wall fascial dehiscence and incisional hernia may occur as a result of large skin and fascia islands as well as muscle required to close these large defects. The purpose of this paper was to describe a novel technique, consisting of VRAM flap donor-site closure with component separation technique, performed on the contralateral side as the flap harvest, allowing for a lower tension closure between ipsilateral external oblique/internal oblique/transverse abdominis muscles complex and contralateral rectus abdominis muscle. In 10 patients undergoing this technique, no abdominal fascial dehiscence, incisional hernia, or parastomal hernia occurred during a mean follow-up of 15 months. Overall 3-year patient survival rate was 80% with abdominal hernia free-survival rate of 100%. The addition of this technique represents an advance in overall patient care to provide a more successful outcomes in this complex scenario.
authors.affiliation: From the *Plastic Surgery Division and †Colorectal Surgery Division, Departamento de Cirugia, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga, Mexico City, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Espinosa-de-Los-Monteros
authors.forename: Lilian
authors.initials: L
authors.lastname: Arista-de la Torre
authors.forename: Omar
authors.initials: O
authors.lastname: Vergara-Fernandez
authors.forename: Noel
authors.initials: N
authors.lastname: Salgado-Nesme
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000637:transplantation*; D010385:Pelvic Exenteration; D019651:Plastic Surgery Procedures / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D017568:Rectus Abdominis / Q000637:transplantation*