Versatilidad del colgajo VRAM / Versatility of the VRAM flap

Los defectos extensos de la pared abdominal y de la zona perineal derivados de las resecciones tumorales o posteriores a procesos infecciosos pueden ser resueltos de una manera rápida y sin la ayuda de técnicas microquirúrgicas mediante el colgajo VRAM, una herramienta reconstructiva importante que ha entrado en desuso, pero que sin lugar a dudas es una estrategia que proporciona seguridad para el cirujano plástico en los casos indicados. En nuestro trabajo se describe una serie de casos en los que se utilizó al colgajo VRAM para la reconstrucción de defectos en pared abdominal y la zona perineal; defectos amplios que fueron satisfactoriamente resueltos, en donde se denotan las ventajas que ofrece este colgajo para la resolución de problemas reconstructivos de las áreas anatómicas en cuestión.

Extensive defects of the abdominal wall and perineal area derived from tumor resections or after infectious processes can be resolved quickly and without the help of microsurgical techniques using the VRAM flap, an important reconstructive tool that an important reconstructive tool that that has gone into disuse, but without a doubt it is a strategy that provides security for the plastic surgeon in the indicated cases. In our work, a series of cases are described in which the VRAM flap was used for the reconstruction of defects in the abdominal wall and the perineal area; large defects that were satisfactorily resolved, where the advantages offered by this flap for the resolution of reconstructive problems of the anatomical areas in question are denoted.

Reconstrucción perineal con colgajo miocutáneo vertical de recto anterior del abdomen luego de amputación abdomino perineal extraelevador. Una alternativa factible para el cirujano colorrectal / Perineal reconstruction with vertical myocutaneous flap of the anterior rectus abdominis after extra-elevating perineal abdominal amputation. A feasible alternative for the colorectal surgeon

Las complicaciones perienales luego de la amputación abdominoperineal son frecuentes y clínicamente relevantes en términos de estadía hospitalaria, costos, calidad de vida y los resultados oncológicos. La utilización creciente de radioterapia pre operatoria y la incorporación gradual a la técnica extra-elevador, ha llevado a un aumento en la morbilidad perineal. Es por elloque la búsqueda de una técnica confiable y con buenos resultados para el cierre perineal se hace necesaria. Se han publicado muchas series que describen diferentes técnicas de cierre del defecto perineal, pero faltan estudios clínicos de alta calidad que indiquen cuál es la mejor opción. Cuando la proctectomía resulta en un amplio defecto perineal, el colgajo vertical del recto del abdomen parece ser la mejor opción. Presentamos dos casos de tumores anorectales localmente avanzados en los que se realizó una amputación abdominoperineal extraelevador con posterior reconstrucción perineal con colgajo de recto anterior y, a su vez, describimos la técnica quirúrgica. (AU)

Perineal complications after abdominoperineal amputation are frequent and clinically relevant in terms of hospital stay, costs, quality of life and oncological results. The growing utilization of pre-operative radiotherapy and the gradual incorporation to the extra-elevator technique, has leaded to an increase in perineal morbidity. That is why the search for a reliable technique with good postoerative outcomes for the perineal closure is necessary. Many series describing different closure techniques of the perineal defect have been published, but high quality clinical studies have to indicate which the best option is. When the proctectomy results in a wide perineal defect, the vertical rectus abdominis flap seems to be the best option. We presented two cases of locally advanced anorectal tumors in which an extraelevatory abdominoperineal amputation was carried out with posterior perineal reconstruction with vertical rectus abdomins flap and we described the surgical technique. (AU)

Reconstrucción de gran defecto de pared abdominal: utilizando el colgajo VRAM en forma bilateral / Reconstruction of extensive compromise of abdominal wal: using bilateral VRAP flap

Presentamos el caso de extenso defecto con compromiso total de pared abdominal lateral, de 27 cm² x 25 cm², resultado de la resección de fibrohistiocitoma maligno, cuya reconstrucción fue realizada en forma inmediata, utilizando el epiplón mayor para el aislamiento del contenido abdominal, sobre el cual fue colocada y fijada una malla de polipropilero Prolite R, y finalmente se procedió al cierre completo del defecto utilizando el colgajo tipo músculo cutáneo vertical de recto abdominal bilateralmente.

We present a case of an extensive compromise lateral and total abdominal wall defect of 25 cm² x 27cm² result thickness, after resection of a malignant fibrohystiocytoma. The reconstruction was done immediately utilizing the greater omemtum to isolate the abdominal content, with a polypropilene Prolite R mesh placed and it is fixed on top, and finally we procedure to complete closure of the extends defect, it was achieved by using a bilateral vertical rectus abdominis musculocutaneous flap.

Clinical significance of muscle sparing verticle rectus abdominis myocutaneous flap for vaginal reconstruction / 中华医学美学美容杂志

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.