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vascularized tissue tilted our choice towards over sacrococcygeal defect with rectus muscle References Consent
Pedicled, Inferiorly based Vertical Rectus filling the pelvic cavity and Gluteus maximus Patients have given their consent for the
Abdominis Myocutaneous (VRAM) flap with flaps closing the lateral aspect of defect. pictures to be published academically.
Gluteus Maximus Myocutaneous Flap. Also, the [1] Kiricuta I. The use of the great omentum
need to change the position for the completion in the surgery of breast cancer. Presse Financial support & sponsorship
of resection facilitated our approach for the Med. 1963;5(71):15–7
aforementioned flaps. Nil
[2] Weinzweig N, Yetman R. Transposition of
the greater omentum for recalcitrant median Conflicts of interest
Patient was placed in the supine position first
and through a midline laparotomy incision the sternotomy wound infections. Ann Plast Surg There are no conflicts of interest.
oncosurgeon completed the abdominal part of 1995;34:471–7
APR, leaving the closed distal end of colon in
the pelvic cavity. [3] Das SK. The size of the human omentum and
methods of lengthening it for transplantation.
Br J Plast Surg 1976;29:170–4
Then VRAM was harvested and was rotated
180° on DIEA pedicle and was tunneled via Figure 8
an intraperitoneal, rectovesical route into the [4] Coombs DM, Patel NB, Zeiderman MR,
pelvis. Tunneling the flap intraperitoneally Wong MS. The Vertical Rectus Abdominis
increased its usable length. [4] Figure 8 Post operative day 7 Musculocutaneous Flap As a Versatile and Viable
Bilateral Gluteus maximus flap based on the Option for Perineal Reconstruction. Eplasty.
The patient was turned into jack-knife position superior gluteal artery provides adequate 2017;17:ic2
and oncosurgery team performed the wide tissue for coverage of sacral defects up to 12
local excision and completed the perineal part cm. The flap is usually transferred as a rotation [5] Allen RJ, Tucker C. Superior gluteal artery
of APR along with the resection of S3, S4 and flap with a 25–40° arc of rotation. The pivot perforator free flap for breast reconstruction.
coccyx and we were left with a sizeable defect. point is in the medial third of the base. In GM Plast Reconstr Surg 1995;95:1207–12
musculocutaneous pedicled flaps, sectioning
of the lateral insertion of the GM on the greater [6] Mathes JM, Nahai F, editors. Clinical
trochanter, partially or totally, provides a larger applications for muscle and musculocutaneous
arc of rotation. The flaps are then advanced in flaps. St Louis: Mosby; 1982. p. 426–32
V-Y fashion. [5]

Successful perineal reconstruction provides
wound coverage, facilitates healing, employs
vascularized tissue with sufficient bulk, maintains
urogenital and anorectal function, and helps
sustain upright posture and ambulation. [6]

Message

Reconstructing a complex oncological defect is
Figure 7 just like solving a Rubik’s cube. One should not
be afraid to accept challenges and should do
Figure 7 Bilateral Gluteus Maximus Flap his/her homework well, dig deep into literature,
was planned and incision made over the where you will always find a similar problem.
superolateral aspect of the gluteal region. Planning is 50% work in such complex defects,
Insetting of flaps was done in a manner in 50 % is then execution and post operative care.
which VRAM was positioned in the centre

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