Technical Considerations to Avoid Microvascular Complications during Groin Lymph Node Free Flap Transfer

while the sarcoma was being resected. This resulted in a shorter operative time, less blood loss, and a faster postoperative recovery. Finally, the arc of rotation of the ORAM flap was preferable to that of the ALT flap, which would have required a ‘U-turn’ to project the flap into the scrotum. It is critical to repair the fascial defect at and around the deep and superficial ring of the inguinal canal, as this fascia layer reduces the risk of future inguinal hernias. After measuring the fascial defect over the deep inguinal ring (5 × 3 cm), we harvested equal dimensions of the left anterior rectus sheath as part of the myocutaneous flap. This anterior rectus sheath was then used after tunneling the flap to close the fascial defect over the deep inguinal ring, replacing like with like. This avoided the use of a synthetic mesh, which would have carried a risk of implant infection as well as being more expensive. Instead of using a mesh to close inguinal fascial defects of this type, it would be more prudent to make use of the fascial component of the flap to reconstruct such defects. In conclusion, the contralateral pedicled ORAM flap is an attractive reconstructive option after the radical excision of a spermatic cord liposarcoma.