Urinary Conduits do not Preclude the use of the Ipsilateral Vertical Rectus Abdominis Myocutaneous (VRAM) flap
Alexander T. Nguyen, M.D., Kyle M. Thompson, B.S., Donald P. Baumann, M.D., Charles E. Butler, M.D..
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
The safe use of the ipsilateral vertical rectus abdominis myocutaneous (VRAM) flap with a urinary conduit (UC) has not previously been delineated. When the ipsilateral VRAM is utilized, the optimal location of the UC placement relative to the linea semilunaris (LS) is also unclear. We sought to identify the safety of an ipsilateral VRAM with a UC and the optimal placement of the UC.
Consecutive patients who underwent UC diversion for pelvic exenteration defects with immediate pelvic/perineal reconstruction were retrospectively reviewed. The primary outcome measure was UC hernia on surgical examination or on CT imaging. Patients were classified according to the placement of the UC: 1. intact rectus, not utilized for flap reconstruction; 2. lateral to the LS, through the lateral abdominal wall; or 3. medial to the LS, through the empty rectus sheath.
111 patients had a mean follow-up of 34 (6-139) months. No differences were found in the patient demographics between the three classifications of UC placement. No difference in UC hernia formation was found between placement through the intact rectus muscle vs. lateral to the LS (17% vs 22%, p=0.61). UC placement medial to the LS had a higher incidence of UC hernias (61%) when compared to placement lateral to the LS or through the intact rectus complex (p=0.007 and p=0.002, respectively).
The need for a UC does not preclude the use of the ipsilateral VRAM flap. After VRAM flap harvest, the UC should be placed through the lateral abdominal wall.
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