J reconstr Microsurg 2019; 35(06): 425-429
DOI: 10.1055/s-0038-1677524
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps: A Large Cohort Analysis

Arif Chaudhry
1  Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Jeremie D. Oliver
2  Mayo Clinic School of Medicine, Rochester, Minnesota
,
Krishna S. Vyas
1  Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Nho V. Tran
1  Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Jorys Martinez-Jorge
1  Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
David Larson
3  Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Eric Dozois
3  Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Heidi Nelson
3  Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Oscar J. Manrique
1  Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

23 September 2018

27 November 2018

Publication Date:
18 January 2019 (eFirst)

Abstract

Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution.

Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap.

Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127).

Conclusion The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.