Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas
Figure 2
(a) Preoperative picture showing the dimensions and design of contralateral, laterally oriented
VRAM with a tongue-like extension. The arrow points to the necrotic thigh flap
advocated achieving adequate oncological resection for pelvic osteosarcoma. (b) Intraoperative
picture showing insetting of flap after debridment of the necrotic area. The
distal muscular component of the flap fills the composite defect which helps
resist infection in this potentially infected area. (c) Intraoperative
picture showing coverage of the defect with application of a split thickness
graft on the remaining muscular bed. The arrow points to the tongue-like skin
extension which avoids tension on the vascular pedicle especially after
dividing the origin and insertion and ensures adequate perfusion to the distal
portion of the flap. (d) Late postoperative picture 6 months after completion of chemotherapy course showing
complete survival of the flap with long-term durability and complete take of
the graft.
