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Vulvar reconstruction in post-RT case using the versatile VRAM flap: reporting the rare extrapelvic approach
  1. Upasana Baruah,
  2. Apoorva Tak,
  3. Debabrata Barmon and
  4. Dimpy Begum
  1. Gynaecologic Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India
  1. Correspondence to Dr Apoorva Tak; drapoorvatak90{at}


Although primary vulvovaginal reconstruction following vulvectomy has a significant chance of improving patient outcomes, flap reconstruction is not a recognised component of the accepted standard of care for vulvar cancer. We provide a case of a patient who underwent successful vulvar reconstruction using the extrapelvic vertical rectus abdominis myocutaneous (VRAM) flap. This musculocutaneous flap offers adequate coverage and bulk to the perineal defect after excision in post-irradiated vulvar cancer.

To proceed with sphincter-saving surgery, she was scheduled for neoadjuvant chemoradiation, as the lesion involved the urethra and perineal body. However, she experienced severe grade IV dermatitis after receiving 37 Gy of radiation. Though the lesion had reduced in size, it was still large enough to cause significant perineal deformity.

We performed a vulvar reconstructive surgery using the uncommon but reliable extrapelvic VRAM flap. This well-vascularised VRAM flap is particularly useful in irradiated areas prone to poor healing. Postoperatively, the wound healed well and the patient underwent adjuvant therapy 6 weeks later. We emphasise the advantages of well-perfused muscle for the primary repair of prior irradiated perineal lesions.

  • Vulvovaginal disorders
  • Plastic and reconstructive surgery
  • Cancer intervention

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  • Contributors UB and DBarmon contributed to the conception and design. AT drafted the manuscript and DBegum critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.