Post-operative care of VRAM flaps for perineal reconstruction: results of a UK practice survey and literature review

The trans-pelvic vertical rectus abdominis myocutaneous (VRAM) flap has shown considerable utility in the reconstruction of pelvic defects following abdomino-perineal excision (APE) or total pelvic exenteration (TPE) for pelvic malignancy. These patients are often nursed post-operatively on colorectal wards, or even in outlying hospitals in those Plastics units operating on a hub-and-spoke basis. Protocols for the post-operative care of free flap reconstruction patients are well established and have been shown to reduce major complications1,2.