Component separation improves outcomes in VRAM flap donor sites with excessive fascial tension

Plastic and Reconstructive Surgery
Donald P Baumann, Charles E Butler

Abstract

The vertical rectus abdominis musculocutaneous (VRAM) flap has numerous uses in pelvic reconstruction; however, flap harvest can result in abdominal wall morbidity. The authors hypothesized that combining component separation with fascial advancement closure would result in acceptable surgical donor-site outcomes. Patients were evaluated who underwent VRAM flap reconstruction for contaminated pelvic defects and component separation with fascial advancement closure or tension-bearing primary fascial closure for VRAM flap donor-site defects between 2006 and 2009. The indication for component separation was the inability to approximate fascial edges (1) at all or (2) without excessive fascial tension, creating a high risk of postoperative failure. Primary outcome indicators included wound complications, myofascial laxity, and incisional hernia. Seventy-four patients were included in the study: 15 who underwent component separation and 59 who underwent primary fascial closure. The mean follow-up was 16 months (range, 6 to 39 months). The incidences of seroma, infection, and skin and fascial dehiscence were higher in the primary fascial closure group (39 percent) than in the component separation group (13 percent) (p<0.053). There w...Continue Reading

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Citations

Jul 23, 2011·Langenbeck's Archives of Surgery·Adrien DaigelerHans-Ulrich Steinau
Nov 16, 2013·Current Problems in Surgery·Charles E ButlerMichael J Rosen
Jan 7, 2016·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Pietro G di SummaWassim Raffoul
Feb 25, 2015·Annals of Surgical Oncology·Tae W ChongMichel Saint-Cyr
Jul 26, 2014·Surgical Endoscopy·Noah J SwitzerShahzeer Karmali
Nov 3, 2016·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·A R MortensenP Christensen
Oct 27, 2015·Journal of Surgical Oncology·Fabio GarofaloMaurice Matter
Feb 26, 2016·Plastic and Reconstructive Surgery·Alexander F MericliChris A Campbell
May 17, 2014·Annals of Plastic Surgery·Pietro G di SummaWassim Raffoul
Jul 25, 2019·Plastic and Reconstructive Surgery. Global Open·Lauren E Buchanan, Chris A Campbell
Mar 12, 2020·JPRAS Open·A O Wamalwa, S O Khainga
Dec 1, 2021·Plastic and Reconstructive Surgery·Christie BialowasAshit Patel

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