Treatment outcomes after pelvic exenteration with IGAM or VRAM flap reconstruction: Review of 130 consecutive cases

Background: Pelvic exenteration (PE) is an extensive surgical procedure with high perioperative morbidity. Although the vertical rectus abdominis myocutaneous (VRAM) flap is considered the gold standard for reconstructing complex perineal defects, it is associated with substantial donor (10-20%) and recipient (20-30%) site complications. An alternative form of locoregional flap reconstruction, the inferior gluteal artery myocutaneous (IGAM) flap was introduced. This study evaluated flap-specific complications, donor associated morbidity and compared the treatment outcomes in patients undergoing VRAM or IGAM reconstructions following PE. Methods: Data were prospectively collected and retrospectively reviewed for adult patients treated at Peter MacCallum Cancer Centre, Melbourne, Australia between January 2008 and 2020. Statistical analyses assessed the relationships between patient demographics, clinical features, reconstructive characteristics, and treatment outcomes. The primary outcome was the occurrence of partial or total flap failure. Secondary outcomes included early return to theatre (RTT), wound dehiscence, surgical site infection, perioperative transfusion, and chronic pain. Results: Among the 130 patients (97.7% previously irradiated), 56 (43.1%) received IGAM and 74 (56.9%) received VRAM flap reconstructions. The median overall survival was 74.3 months and the 5-year overall survival was 56.2%. Univariate analysis demonstrated that VRAM flaps were significantly associated with higher rates of flap failure (p = 0.01), early RTT, dehiscence, and infection (p < 0.001) compared with IGAM. Multivariate logistic regression confirmed increased adverse outcomes in the VRAM sub-group. Conclusion: In this study, IGAM flaps showed lower flap-specific complications, reduced donor morbidity, and improved treatment outcomes. These findings support the IGAM as the preferred flap choice over VRAMs for reconstructing complex perineal defects after PE. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.