ePlasty: Vol. 17
The Vertical Rectus Abdominis Musculocutaneous Flap As a Versatile and Viable Option for Perineal Reconstruction
Demetrius M. Coombs, BS,a Nirav B. Patel, MD, MS, JD,b Matthew R. Zeiderman, MD,b and Michael S. Wong, MDb

aDrexel University College of Medicine, Philadelphia, Pa; and bDivision of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, Ca

Correspondence: dmcoombs@mac.com
Keywords: perineal reconstruction, VRAM, squamous cell carcinoma, radiation-induced tissue damage, wound healing


A 55-year-old man with a history of squamous cell carcinoma of the anus status-post radiation presented with an ulcerated lesion warranting pelvic exenteration and abdominoperineal resection (APR) and leaving a significant soft-tissue defect involving the right perineum. A right vertical rectus abdominis musculocutaneous (VRAM) flap was selected for reconstruction.


1. What reconstructive options exist in the plastic surgeon's arsenal that address defects of the perineum? In brief, what are the advantages of each?

2. When planning a procedure for perineal reconstruction, what are the indications for harvesting a VRAM flap?

3. In brief, what is the effect of radiation-induced tissue damage on reconstructive surgical outcomes and, ultimately, on wound healing?

4. What postoperative complications are most ty .......