{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:10:03Z","timestamp":1756375803544,"version":"3.44.0"},"reference-count":32,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,3,23]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>Although primary vulvovaginal reconstruction following vulvectomy has a significant chance of improving patient outcomes, flap reconstruction is not a recognised component of the accepted standard of care for vulvar cancer. We provide a case of a patient who underwent successful vulvar reconstruction using the extrapelvic vertical rectus abdominis myocutaneous (VRAM) flap. This musculocutaneous flap offers adequate coverage and bulk to the perineal defect after excision in post-irradiated vulvar cancer.<\/jats:p>\n               <jats:p>To proceed with sphincter-saving surgery, she was scheduled for neoadjuvant chemoradiation, as the lesion involved the urethra and perineal body. However, she experienced severe grade IV dermatitis after receiving 37 Gy of radiation. Though the lesion had reduced in size, it was still large enough to cause significant perineal deformity.<\/jats:p>\n               <jats:p>We performed a vulvar reconstructive surgery using the uncommon but reliable extrapelvic VRAM flap. This well-vascularised VRAM flap is particularly useful in irradiated areas prone to poor healing. Postoperatively, the wound healed well and the patient underwent adjuvant therapy 6\u2009weeks later. We emphasise the advantages of well-perfused muscle for the primary repair of prior irradiated perineal lesions.<\/jats:p>","DOI":"10.1136\/bcr-2023-254773","type":"journal-article","created":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T10:30:14Z","timestamp":1680863414000},"page":"e254773","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Vulvar reconstruction in post-RT case using the versatile VRAM flap: reporting the rare extrapelvic approach"],"prefix":"10.1136","volume":"16","author":[{"given":"Upasana","family":"Baruah","sequence":"first","affiliation":[{"name":"Gynaecologic Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7169-4877","authenticated-orcid":false,"given":"Apoorva","family":"Tak","sequence":"additional","affiliation":[{"name":"Gynaecologic Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debabrata","family":"Barmon","sequence":"additional","affiliation":[{"name":"Gynaecologic Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimpy","family":"Begum","sequence":"additional","affiliation":[{"name":"Gynaecologic Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, Assam, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,4,7]]},"reference":[{"key":"2025082802452901000_16.4.e254773.1","doi-asserted-by":"crossref","first-page":"3623","DOI":"10.1200\/JCO.21.00006","article-title":"Radiotherapy versus inguinofemoral lymphadenectomy as treatment for vulvar cancer patients with micrometastases in the sentinel node: results of GROINSS-V II","volume":"39","author":"Oonk","year":"2021","journal-title":"J Clin Oncol"},{"key":"2025082802452901000_16.4.e254773.2","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1200\/GO.20.00122","article-title":"Cancer statistics, 2020: report from national cancer registry programme, India","volume":"6","author":"Mathur","year":"2020","journal-title":"JCO Glob Oncol"},{"key":"2025082802452901000_16.4.e254773.3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/ijgo.13881","article-title":"Cancer of the vulva: 2021 update","volume":"155 Suppl 1","author":"Olawaiye","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"key":"2025082802452901000_16.4.e254773.4","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s13224-019-01261-z","article-title":"An overview of vulvar cancer: a single-center study from Northeast India","volume":"69","author":"Nandwani","year":"2019","journal-title":"J Obstet Gynaecol India"},{"key":"2025082802452901000_16.4.e254773.5","article-title":"Perforator flaps for vulvar reconstruction: basic principles","volume":"93","author":"Raposio","year":"2022","journal-title":"Acta Biomed"},{"key":"2025082802452901000_16.4.e254773.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2011.09.003"},{"key":"2025082802452901000_16.4.e254773.7","first-page":"823","article-title":"Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery","volume":"74","author":"Soper","year":"1989","journal-title":"Obstet Gynecol"},{"key":"2025082802452901000_16.4.e254773.8","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/0002-9378(89)90168-3","article-title":"Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration","volume":"160","author":"Copeland","year":"1989","journal-title":"Am J Obstet Gynecol"},{"key":"2025082802452901000_16.4.e254773.9","doi-asserted-by":"crossref","DOI":"10.1136\/bcr.01.2011.3717","article-title":"Vulva reconstruction after pelvic exenteration, using a unique combination of two flaps","volume":"2011","author":"van Bommel","year":"2011","journal-title":"BMJ Case Rep"},{"key":"2025082802452901000_16.4.e254773.10","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/01.AOG.0000154158.41973.a2","article-title":"Novel modification of the vertical rectus abdominis myocutaneous flap for neovagina creation","volume":"105","author":"Sood","year":"2005","journal-title":"Obstet Gynecol"},{"key":"2025082802452901000_16.4.e254773.11","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.ygyno.2005.01.032","article-title":"Rectus abdominis myocutaneous and myoperitoneal flaps for neovaginal reconstruction after radical pelvic surgery: comparison of flap-related morbidity","volume":"97","author":"Soper","year":"2005","journal-title":"Gynecol Oncol"},{"key":"2025082802452901000_16.4.e254773.12","unstructured":"NCCN guidelines version 1.2022, vulvar cancer. 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