Vertical rectus abdominis myocutaneous (VRAM) flap inguinal reconstruction combined with lymphatic venous anastomosis (LVA) after oncological resection – a case report and literature review. Case report

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Julia Radziszewska
Natalia Krześniak
Marcin Radziszewski
Piotr Gierej

Abstract

Introduction: The vertical rectus abdominis myocutaneous (VRAM) flap is one of the possible solutions to cover large tissue defects after oncological resection in the inguinal region. Its efficacy can be impaired due to recipient site tissue damage following radiotherapy as well as due to lymphadenectomy, often resulting in lymphoedema and persistent lymphatic leakage.


Case report: Contralateral VRAM reconstruction was performed in a 50-year-old male patient with a nonhealing inguinal wound following right thigh sarcoma excision and radiotherapy. To improve the flap performance, we combined VRAM surgery with lymphatic venous anastomosis (LVA) to the contralateral inferior epigastric vein. An immediate stoppage of the lymphatic leakage occurred as well as after the surgery a lower extremity edema reduction was observed (varying from 2 to 7 cm of leg circumference, depending on the level of the measurement).


Discussion: It is possible that LVA enabled proper flap healing and improved lymphatic drainage; however, it is also probable that a similar effect could have been achieved with the VRAM flap alone.


Conclusion: This case report indicates that LVA could improve VRAM flap performance in inguinal reconstruction procedures and reduce lymphedema and lymphorrhea; however, further research is needed.

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How to Cite
1.
Radziszewska J, Krześniak N, Radziszewski M, Gierej P. Vertical rectus abdominis myocutaneous (VRAM) flap inguinal reconstruction combined with lymphatic venous anastomosis (LVA) after oncological resection – a case report and literature review. OncoReview [Internet]. 2023Dec.29 [cited 2024Apr.22];13(4(52):103-8. Available from: https://journalsmededu.pl/index.php/OncoReview/article/view/2966
Section
PERSONALIZED ONCOLOGY

References

1. Gürlek A, Miller MJ, Amin AA et al. Reconstruction of complex radiation-induced injuries using free-tissue transfer. J Reconstr Microsurg. 1998; 14(5): 337-40. http://doi.org/10.1055/s-2007-1000187.
2. Jeanne-Julien A, Bouchot O, De Vergie S et al. Morbidity and risk factors for complications of inguinal lymph node dissection in penile cancer. World J Urol. 2023; 41(1): 109-18. http://doi.org/10.1007/s00345-022-04169-y.
3. Sörelius K, Schiraldi L, Giordano S et al. Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo. 2019; 33(1): 1-9. http://doi.org/10.21873/invivo.11431.
4. Sánchez-García A, García Moreno MÁ, Salmerón-González E et al. Inguinal Reconstruction Using Pedicled Rectus Abdominis Flap: A Useful Option for the Application of Radiotherapy. Plast Surg Nurs. 2019; 39(2): 41-3. http://doi.org/10.1097/PSN.0000000000000256.
5. Radwan RW, Tang AM, Harries RL et al. Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review. J Plast Reconstr Aesthet Surg. 2021; 74(3): 523-9. http://doi.org/10.1016/j.bjps.2020.10.100.
6. Scaglioni MF, Meroni M, Fritsche E et al. Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema-lymphocele prevention in thigh sarcoma surgery: Preliminary results. J Surg Oncol. 2021; 123(1): 96-103. http://doi.org/10.1002/jso.26228.
7.Witt RG, Cope B, Erstad DJ et al. Sentinel Lymph Node Biopsy and Formal Lymphadenectomy for Soft Tissue Sarcoma: A Single Center Experience of 86 Consecutive Cases. Ann Surg Oncol. 2022; 29(11): 7092-100. http://doi.org/10.1245/s10434-022-11803-x.
8. Tasch C, Pattiss A, Maier S et al. Free Flap Outcome in Irradiated Recipient Sites: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2022; 10(3): e4216. http://doi.org/10.1097/GOX.0000000000004216.
9. Scaglioni MF, Fontein DBY, Arvanitakis M et al. Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery. 2017; 37(8): 947-53. http://doi.org/10.1002/micr.30246.
10. Giacalone G, Yamamoto T, Hayashi A et al. Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea. Microsurgery. 2019; 39(4): 326-31. http://doi.org/10.1002/micr.30435.
11. Miranda Garcés M, Pons G, Mirapeix R et al. Intratissue lymphovenous communications in the mechanism of action of vascularized lymph node transfer. J Surg Oncol. 2017; 115(1): 27-31. http://doi.org/10.1002/jso.24413.
12. Slavin SA, Upton J, Kaplan WD et al. An investigation of lymphatic function following free-tissue transfer. Plast Reconstr Surg. 1997; 99(3): 730-43. http://doi.org/10.1097/00006534-199703000-00020.