TURBO CHARGING THE VERTICAL RECTUS-ABDOMINIS MYOCUTANEOUS (TURBO-VRAM) FLAP FOR RECONSTRUCTION OF EXTENSIVE CHEST-WALL DEFECTS

We report our experience using ''turbo charging'' of the vertical rectus abdominis myocutaneous (turbo-VRAM) flap in 7 patients with extensive chest wall defects. The turbo-VRAM flap provides augmented blood supply with microvascular anastomosis between the inferior epigastric system and available vessels of the axillary, brachial or cervical vascular system. All patients in this study had uncomplicated recovery. In 3 patients, the skin paddle of the flap, which was designed as a fish shape, was effectively used to cover a wide defect. One patient required resection of some lower costal cartilages located near the superior epigastric vascular system in order to extend the rotation distance of the flap. These technical options have made the turbo-VRAM flap more versatile. The turbo-VRAM flap allows successful coverage of extensive chest wall defects, including defects of the axilla, upper arm, shoulder, or neck.