Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas
Figure 1
(a) A two-week picture after delay procedure (surgical and vascular delay) for extended
inferiorly based VRAM flap. The arrow points to line of demarcation between nonperfused
and augmented perfused skin in the parasternal fasciocutaneous extension of the
VRAM flap. This extension provided additional predictable length of 7 cm for
coverage of exposed plate femur after osteosarcoma resection of the proximal femur. (b) Intraoperative
picture after harvesting of VRAM flap and debridement of necrotic thigh flap.
The VRAM extension marked by the suture markings of the delay procedure
provides the extra length avoiding tension and providing durable coverage. (c) Postoperative
picture 3 months during chemotherapy course showing complete survival of the
flap providing stable coverage and complete healing of the donor site.
