{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:52:32Z","timestamp":1791366752982,"version":"4.3.1"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Abdominoperineal resection (APR) and pelvic exenteration create large, frequently irradiated three-dimensional defects with expectedly high complication rates. The oblique rectus abdominis myocutaneous (ORAM) flap offers an articulated skin paddle with variable thickness and the potential for muscle-sparing harvest. We report our experience using ORAM flaps for pelvic, perineal, and vaginal reconstruction following oncologic resection and compare our results with pooled vertical rectus abdominis muscle (VRAM) flap outcomes derived from the published literature.<\/jats:p>\n                  <jats:p>We conducted a retrospective review of consecutive patients undergoing ORAM flap reconstruction after APR or pelvic exenteration (July 2016\u2013September 2025). Demographics, oncologic treatments, operative details, and outcomes were abstracted and compared with pooled VRAM reference rates extracted from large published series and systematic reviews. Our primary outcomes were flap survival, recipient and donor site complications, and reoperation. Subgroup analysis examined risk factors for complications and whether vaginal reconstruction was performed.<\/jats:p>\n                  <jats:p>A total of 26 patients underwent ORAM reconstruction. The cohort was predominantly female (73%) with a mean age of 58.2 years and body mass index of 27.5\u2009kg\/m2. Ninety-two percent of patients received neoadjuvant radiation. Most reconstructions used pedicled ORAM flaps (96%), whereas in one case a free ORAM flap was used. Median follow-up was 3.2 months. Complete flap loss occurred in one patient (4%) and partial necrosis in two patients (8%). Recipient site delayed healing occurred in 35% and donor site delayed healing in 31%. Compared with pooled VRAM controls, ORAM outcomes did not differ significantly for complete flap loss (3.8 vs. 1.8\u20132.3%, p\u2009=\u20090.38), perineal wound morbidity (34.6 vs. 22.5\u201327%, p\u2009=\u20090.22), reoperation (15.4 vs. 10.1%, p\u2009=\u20090.33), or perineal hernia (0 vs. 0.2%, p\u2009=\u20091.00). Donor site delayed healing was numerically higher than the pooled VRAM estimate (30.8 vs. 15\u201317%) but not statistically different in comparison (p\u2009=\u20090.10). In 18 patients requiring vaginal reconstruction, the thinner distal skin paddle enabled creation of a neovaginal vault with favorable early functionality.<\/jats:p>\n                  <jats:p>The ORAM flap provides a reliable and versatile flap for reconstruction of large pelvic defects after cancer extirpation. The articulated design with proximal soft tissue bulk for filling dead space and thinner distal skin for lining facilitates simultaneous pelvic, perineal, and vaginal reconstruction. Careful attention to perforator number and preoperative risk modification may further optimize outcomes.<\/jats:p>","DOI":"10.1055\/a-2968-4536","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T23:16:28Z","timestamp":1790378188000},"source":"Crossref","is-referenced-by-count":0,"title":["The Versatile ORAM Flap: A Microsurgeon's Pedicled Flap for Perineal Reconstruction Compared with Reported VRAM Outcomes"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2617-4124","authenticated-orcid":false,"given":"Amir","family":"Dehdashtian","sequence":"additional","affiliation":[{"name":"University of Michigan, Michigan, United States","place":["Ann Arbor"],"department":["Department of Surgery, Section of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey E.","family":"Hespe","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center, New York, United States","place":["New York"],"department":["Department of Surgery, Plastic and Reconstructive Surgery Service"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore A.","family":"Kung","sequence":"additional","affiliation":[{"name":"University of Michigan, Michigan, United States","place":["Ann Arbor"],"department":["Department of Surgery, Section of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1007\/s10350-004-0827-1","article-title":"Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure","volume":"48","author":"K M Bullard","year":"2005","journal-title":"Dis Colon Rectum"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1067\/msy.2001.117100","article-title":"Primary closure of complicated perineal wounds with myocutaneous and fasciocutaneous flaps after proctectomy for Crohn's disease","volume":"130","author":"R D Hurst","year":"2001","journal-title":"Surgery"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/BF02235190","article-title":"Persistent perineal sinus after proctocolectomy for Crohn's disease","volume":"42","author":"T Yamamoto","year":"1999","journal-title":"Dis Colon Rectum"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/codi.15956","article-title":"Empty pelvis syndrome: a systematic review of reconstruction techniques and their associated complications","volume":"24","author":"Y L Johnson","year":"2022","journal-title":"Colorectal Dis"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/codi.14523","article-title":"Addressing the empty pelvic syndrome following total pelvic exenteration: does mesh reconstruction help?","volume":"21","author":"P Lee","year":"2019","journal-title":"Colorectal Dis"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.jamcollsurg.2007.12.007","article-title":"Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects","volume":"206","author":"C E Butler","year":"2008","journal-title":"J Am Coll Surg"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1245\/s10434-018-6363-3","article-title":"Vertical rectus abdominis musculocutaneous flap repair improves perineal wound healing after abdominoperineal resection for irradiated locally advanced rectal cancer","volume":"25","author":"M Spasojevic","year":"2018","journal-title":"Ann Surg Oncol"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1245\/ASO.2005.03.100","article-title":"Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study","volume":"12","author":"D B Chessin","year":"2005","journal-title":"Ann Surg Oncol"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1245\/s10434-012-2503-3","article-title":"Vaginal reconstruction following radical surgery for colorectal malignancies: a systematic review of the literature","volume":"19","author":"A McArdle","year":"2012","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/PRS.0b013e3181904df7","article-title":"Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects","volume":"123","author":"R A Nelson","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"ref11","first-page":"91","volume-title":"Pelvic reconstruction after abdominoperineal resection: is it worthwhile?","author":"C E Butler","year":"2005"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/PRS.0000000000000324","article-title":"Comparison of vertical and oblique rectus abdominis myocutaneous flaps for pelvic, perineal, and groin reconstruction","volume":"134","author":"P D Combs","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/01.sap.0000099820.10065.2a","article-title":"Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps","volume":"52","author":"E W Buchel","year":"2004","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/DCR.0b013e31827a267c","article-title":"Dynamic article: vaginal and perineal reconstruction using rectus abdominis myocutaneous flap in surgery for locally advanced rectum carcinoma and locally recurrent rectum carcinoma","volume":"56","author":"F A Holman","year":"2013","journal-title":"Dis Colon Rectum"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/00006534-198312000-00001","article-title":"The extended deep inferior epigastric flap: a clinical technique","volume":"72","author":"G I Taylor","year":"1983","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/01.PRS.0000131878.52740.EA","article-title":"The oblique rectus abdominis musculocutaneous flap: revisited clinical applications","volume":"114","author":"M J Lee","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.bjps.2021.08.024","article-title":"Immediate vaginal and perineal reconstruction after abdominoperineal excision using the inferior gluteal artery perforator flap (V-IGAP)","volume":"75","author":"K S Johal","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/PRS.0b013e3181f95a54","article-title":"Extended vertical rectus abdominis myocutaneous flap for pelvic reconstruction: three-dimensional and four-dimensional computed tomography angiographic perfusion study and clinical outcome analysis","volume":"127","author":"M Villa","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/PRS.0b013e3181774330","article-title":"The vertical and extended rectus abdominis myocutaneous flap for irradiated thigh and groin defects","volume":"122","author":"B M Parrett","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref20","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1007\/s10350-008-9359-4","article-title":"The oblique rectus abdominal myocutaneous flap for complex pelvic wound reconstruction","volume":"51","author":"D E Abbott","year":"2008","journal-title":"Dis Colon Rectum"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.bjps.2024.04.037","article-title":"Short- and long-term morbidity after Taylor flap (oblique rectus abdominis flap) for perineal reconstruction after abdominoperineal resection: a single-center series of 140 patients","volume":"93","author":"D Boccara","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1097\/00006534-198811000-00014","article-title":"The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system","volume":"82","author":"H K Moon","year":"1988","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.bjps.2020.10.100","article-title":"Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: a systematic review","volume":"74","author":"R W Radwan","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s00268-020-05788-5","article-title":"Donor site morbidity of patients receiving vertical rectus abdominis myocutaneous flap for perineal, vaginal or inguinal reconstruction","volume":"45","author":"V S Schellerer","year":"2021","journal-title":"World J Surg"},{"key":"ref25","volume-title":"Abdominoperineal Resection","author":"G Menon","year":"2025"},{"issue":"07","key":"ref26","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1007\/s00268-021-06044-0","article-title":"Outcomes following immediate vertical rectus abdominis myocutaneous (VRAM) flap\u2010based perineal reconstruction following resectional surgery for pelvic malignancies","volume":"45","author":"R L Harries","year":"2021","journal-title":"World J Surg"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10029-025-03406-8","article-title":"Incisional and parastomal hernias after harvesting of vertical rectus abdominis myocutaneous (VRAM) flaps: incidence, treatment options and outcomes","volume":"29","author":"C Vervaet","year":"2025","journal-title":"Hernia"},{"issue":"04","key":"ref28","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1111\/codi.16400","article-title":"Radiological incidence of donor-site incisional hernia and parastomal hernia after vertical rectus abdominus myocutaneous flap-based reconstruction following colorectal surgery","volume":"25","author":"A M Tang","year":"2023","journal-title":"Colorectal Dis"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/annonc\/mdr133","article-title":"Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review","volume":"23","author":"M J Traa","year":"2012","journal-title":"Ann Oncol"},{"issue":"12","key":"ref30","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1111\/codi.16767","article-title":"A systematic review of female sexual function after surgery for locally advanced or recurrent colorectal cancer - first step to filling the knowledge gap","volume":"25","author":"E Platteau","year":"2023","journal-title":"Colorectal Dis"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2968-4536.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:12:32Z","timestamp":1791364352000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2968-4536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1055\/a-2968-4536","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9,25]]},"published":{"date-parts":[[2026,9,25]]}}}