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Volume 2008, Article ID 781408, 6 pages
Clinical Study

Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

1Department of General Surgery, King's College Hospital, Denmark Hill, London SE59RS, UK
2Department of Plastic and Reconstructive Surgery, Cairo University Teaching Hospital, Cairo University, Kasr Al Ainy, Cairo 11559, Egypt
3Center of Preservation and Musculoskeletal Tissue Transfer, Cairo University Teaching Hospital, Kasr Al Ainy, Cairo University, Cairo 11559, Egypt
4Division of Plastic & Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
5Department of Surgery, Royal Free Hospital, London NW3 2PN, UK

Received 7 June 2007; Revised 6 September 2007; Accepted 26 December 2007

Academic Editor: Ajay Puri

Copyright © 2008 Haitham H. Khalil et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM) flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005), 5 men and 2 women were managed. Median age was 21 years (range 15–49). The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases) or a delayed extended VRAM flap (2 cases). Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.