Two-Stage Delayed Pedicled Vertical Rectus Abdominis Myocutaneous (VRAM) Flap for High-Risk Sternal Reconstruction: A Tertiary Referral Center Experience
17 th Congress of the European Federation of Societies for Microsurgery in Prague, Praha, Çek Cumhuriyeti, 14 - 17 Haziran 2026, (Özet Bildiri)
- Yayın Türü: Bildiri / Özet Bildiri
- Basıldığı Şehir: Praha
- Basıldığı Ülke: Çek Cumhuriyeti
- İstanbul Üniversitesi-Cerrahpaşa Adresli: Evet
Özet
Two-Stage Delayed Pedicled Vertical Rectus Abdominis Myocutaneous (VRAM) Flap for High-Risk Sternal Reconstruction: A Tertiary Referral Center Experience
Authors: Çağlar YILMAZ, Arjin KAYA, Anıl DEMİROZ
Affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
Background
Sternal reconstruction in high-risk patients following cardiac surgery is associated with increased rates of distal flap necrosis and wound complications. The pedicled vertical rectus abdominis myocutaneous (VRAM) flap is a reliable reconstructive option; however, compromised perfusion may limit distal skin paddle viability. The surgical delay phenomenon enhances flap perfusion through vascular conditioning and dilation of choke vessels. This study presents our tertiary referral center experience using a two-stage delayed VRAM protocol in high-risk sternal reconstruction.
Methods
A retrospective review was performed of patients undergoing staged delayed pedicled VRAM flap reconstruction for complex sternal defects. Indications included post-sternotomy mediastinitis, multiple prior debridements, diabetes mellitus, obesity, or previous radiation. In the first stage, partial flap elevation and pedicle ligation were performed. Definitive flap transfer was completed 7–14 days later. Outcomes evaluated included flap survival, distal necrosis, venous congestion, revision surgery, donor-site morbidity, and length of hospital stay.
Results
A total of nine patients underwent staged delayed pedicled VRAM flap reconstruction. All flaps survived, and no total flap loss was observed. Minor complications occurred in two patients: one patient developed abdominal bulging requiring mesh revision, and one patient had marginal flap necrosis that healed secondarily with conservative management. No major venous congestion or significant donor-site complications were observed. Revision surgery was infrequent andlimited to the patient requiring mesh reinforcement. The staged approach did not significantly prolong hospitalization.
Conclusion
A two-stage delayed VRAM strategy appears safe and may enhance distal flap reliability in high-risk sternal reconstruction. Surgical delay represents a practical and reproducible vascular conditioning technique in compromised patients. Comparative studies are warranted to further evaluate its benefits.