Work

Postoperative Bladder Distension Leading to Compromised VRAM Flap Perfusion Following Abdominoperineal Reconstruction: A Two-Case Series

Year: 2026

Type: article

Abstract: Vertical rectus abdominis myocutaneous (VRAM) flaps remain a reliable option for perineal reconstruction following abdominoperineal resection (APR). Despite their robust vascularity, postoperative factors can compromise flap perfusion. We present a two-case series of patients who developed flap congestion secondary to postoperative bladder distension after APR with VRAM reconstruction. In both cases, removal of the Foley catheter led to urinary retention, abdominal distension, and venous congestion of the flap. Imaging in one patient demonstrated direct pedicle compression by the distended bladder. Prompt reinsertion of the Foley catheter and decompression restored flap perfusion, with both patients ultimately achieving full healing. To our knowledge, bladder distension as a cause of VRAM flap compromise has not been previously reported. These cases highlight the importance of vigilant postoperative urinary monitoring and consideration of prolonged catheterization protocols to prevent reversible, avoidable flap congestion in perineal reconstructions using pedicled VRAM flaps.

Source: Plastic Surgery

DOI: 10.1177/22925503261429458

Authors: Nicholas S Hernandez, Taylor Waitt, Adam He, Nicholas Lombana, Nicholas Webster

Institutions: Baylor College of Medicine, Baylor Scott & White Medical Center - Temple

Language: English

Topic: Reconstructive Surgery and Microvascular Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,150