The vertical rectus abdominis (VRAM) free flap in head and neck reconstruction – A series of 20 patients

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The vertical rectus abdominis (VRAM) free flap in head and neck reconstruction - A series of 20 patients

K.L.H. Lim: The vertical rectus abdominis (VRAM) free flap in head and neck reconstruction– A series of 20 patients. Mal. J. Oral Maxillofax. Surg. 2002: 2: 12–24.

Abstract:Major defects of the head and neck region require reconstruction withlarge flaps to replace lining and cover, restore contour and disguise underlying boneloss in those cases where bone reconstruction may be inappropriate. Free flaps offera single-stage method of reconstruction, and are usually the treatment of choice.Over a three year period, 20 consecutive patients (14 male, 6 female) rangingin age from 35 to 79 years (mean age = 59.55 years), underwent primaryreconstruction of large tumour related defects in the head and neck region usingthe VRAM free flap. The follow up period ranged from 2 weeks to 42 months(mean follow up period = 15.3 months). 15 of these patients presented withrecurrent tumour, of which 3 had previous reconstruction with free flaps. 18reconstructions were performed in previously irradiated patients, with 2 of thesepatients having also received pre-operative chemotherapy. Subsequent tumourrecurrence in the previously irradiated group was treated with either furtherresection, post-operative radiotherapy or post-operative chemotherapy, with 10deaths occurring during the follow-up period.The VRAM free flap was used in 10 oral cavity reconstructions followingresection of the tongue, floor of mouth and mandible, 3 pharyngo-oesophagealreconstructions following pharyngo-laryngectomy, 3 orbito-maxillaryreconstructions, and 4 facial reconstructions following resection of the verticalramus of mandible without bone reconstruction.This series of 20 consecutive patients confirms the versatility, safety, reliabilityand low donor site morbidity of the VRAM free flap in head and neckreconstruction. We believe this flap is particularly indicated in the previouslyirradiated patient with pain, trismus, infection or osteo-radionecrosis whereresection of the vertical ramus of the mandible is indicated. The VRAM flapprovides good cosmetic and functional reconstruction with symptomatic relief ofboth pain and trismus.