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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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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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
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