Vertical Rectus Abdominis Myocutaneous Flap Reduces Pelvic Exenteration Morbidity: A Retrospective Single‐Centre Cohort Study

Abstract

ABSTRACT Background Pelvic exenteration (PE) has emerged as a viable resection strategy for locally advanced and recurrent pelvic cancers; however, it carries the burden of significant morbidity. The vertical rectus abdominis myocutaneous (VRAM) flap is a reconstructive method designed to minimise postoperative wound complications, and this study highlights its potential for minimising morbidity following PE. Method We present results from a retrospective cohort study of patients undergoing PE at the sole tertiary referral service in Western Australia from 2017 to 2025. Patients were identified from the departmental database and data extracted from electronic records. Data was collected including demographics, operative outcomes, postoperative complications and survival. We analysed complications in those undergoing VRAM flap vs. primary closure and discuss our results. Results Forty‐five patients underwent PE of which 35 patients had colorectal adenocarcinoma, 20 patients received VRAM flaps and 25 underwent primary closure, 11 of whom received mesh reconstruction. Postoperative complications were less frequent in the VRAM group compared with primary closure and we identified 24 patients who developed postoperative pelvic collections (RR = 0.75), 15 who developed deep pelvic infections (RR = 0.31) and 13 who developed superficial perineal wound infections (RR = 0.78). Twenty‐three patients experienced major (Clavien–Dindo ≥ 3) postoperative morbidity, 90‐day overall survival was 97.8%, and 1‐year overall survival was 89.9%. Conclusion VRAM flaps were associated with a reduced incidence of postoperative collections, deep infections and wound infections. Our results are consistent with existing literature and support VRAM flaps as a safe reconstruction technique to minimise postoperative morbidity following PE.