Management of defects in the groin, thigh, and pelvic region with modified contralateral TRAM/VRAM flaps.

In patients with sarcomas, or regional recurrence of the disease, radical resection and radiation therapy is indicated to achieve cure or palliation. As a result of radical surgery, extensive radiation, or infection in the pelvic, groin or thigh region, the development of large pelvic / groin / thigh defects present a difficult surgical problem. Musculocutaneous deep epigastric island-flaps, as a modification of the extended deep inferior epigastric flap, described by Taylor et al. in 1983, are an attractive option for a successful reconstruction for this defect localisation. Two technical modifications of the contralateral extended deep inferior epigastric island-flap permitted an adequate tailoring to a defect in the posterior lateral pelvic or groin-thigh region, and avoided the drawbacks of other loco-regional or microsurgical flaps in previously irradiated fields. The skin island reached the posterior lateral pelvic region, groin or thigh. The muscular portion of this flap was suited to fill the soft tissue defects in these critical areas. These so modified flaps represent an instrument, which in selected cases may be an interesting alternative tool for closure of complex defects. No significant functional impairment secondary to the flap procedures was noted in our patients.