Filling the Depths: Innovative Vertical Rectus Abdominis Myocutaneous (VRAM) Flap Reconstruction in a Complex Deep Tissue Pressure Injury

TL;DR

This paper presents a successful case of using a VRAM flap to reconstruct a complex deep tissue injury in a patient with multiple health issues.

Contribution

The paper introduces the use of a VRAM flap as a novel solution for large, complex deep tissue injuries when traditional methods are not viable.

Findings

A VRAM flap provided successful reconstruction of a large trochanteric wound in a high-risk patient.

The patient showed complete healing at six months without abdominal wall issues.

VRAM flaps are a reliable option for complex deep tissue injuries in the lower extremity.

Abstract

Deep tissue injuries (DTIs) pose significant reconstructive challenges, particularly when involving extensive soft tissue loss and exposure of vital structures. We report a case of a 69-year-old male with multiple comorbidities who developed a complex, full-thickness trochanteric wound following prolonged immobilization after a cardiac event. The injury, characterized by a 19 x 9 cm defect with compromised surrounding tissues - including the tensor fascia - precluded the use of conventional local flaps. Given the size and depth of the defect, a pedicled vertical rectus abdominis myocutaneous (VRAM) flap was selected for its robust vascularity, versatility, and ability to provide ample soft tissue bulk. Complete healing was observed at the six-month follow-up visit with no evidence of abdominal wall compromise or functional deficit. This case illustrates that the VRAM flap is a reliable and effective option for the reconstruction of large, complex DTIs in the proximal lower extremity, particularly when local flap options are compromised.

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