The VRAM flap brings muscle and skin from the abdomen down into the pelvis or perineum. It fills deep space, carries a strong blood supply, and is often chosen when the area has already been treated with radiotherapy.
A VRAM flap uses the vertical rectus abdominis muscle with the skin above it, moved down into the pelvis or perineum on its own blood supply. Surgeons choose it when a deep space needs filling and local tissue has been damaged by radiotherapy. The abdominal wall is then repaired, usually with mesh support.
Deep wounds in the pelvis and perineum need tissue with bulk and a dependable blood supply. This flap provides both. A vertical paddle of skin is marked on the abdomen over the rectus muscle, the muscle is raised on vessels entering from below, and the whole unit is passed down into the pelvis through the abdomen.
Surgeons favour it after radiotherapy, because the tissue comes from outside the treated field. Common uses include wounds after removal of the rectum and anus, pelvic clearance operations, and areas around the vagina or perineum that will not heal. Where a stoma is planned, the side used for the flap is agreed in advance.
Taking rectus muscle leaves the abdominal wall weaker on that side, so the donor area is closed carefully and mesh is often added for support. Drains are placed at both sites. Sitting, hygiene and lifting advice follows, and reviews then check the flap, the abdominal repair and the wound as healing settles.
This flap suits people needing bulky, reliable tissue in the pelvis or perineum, and whose abdominal wall can spare one rectus muscle.
Scars, stoma sites and previous radiotherapy are reviewed, and the side for the flap is agreed with the cancer team. Marking is done before surgery while you are awake and standing.
The pelvic operation is finished first and bleeding is controlled. A dry, clean cavity is needed before any tissue is brought down into it.
The skin paddle and rectus muscle are raised together while the feeding vessels are protected. Careful dissection matters here, since the flap depends entirely on those vessels.
The unit is turned and passed through the abdomen into the pelvis. Positioning avoids twisting or pressure, both of which would reduce the blood supply.
The abdominal wall is repaired and usually reinforced with mesh. Skin is closed, drains are placed at both sites, and a binder is fitted before you first stand.
Care is close, with the flap checked for colour and warmth. Pain relief, fluids and antibiotics run while drains are monitored at both sites.
Walking and eating restart gradually. Discharge follows once wounds are dry, pain is controlled and you can manage hygiene and dressings with support at home.
Sitting and walking feel easier. Reviews check both the flap and the abdominal repair, while lifting and strenuous activity remain restricted.
Strength returns steadily with guided exercise. Scars soften, and the abdominal wall is checked for any bulge developing at the donor site.
Most people gain a healed perineum and a pelvis that no longer collects fluid. Scars run vertically on the abdomen and around the perineum, and the abdominal wall may feel weaker on the side used. Numbness at both sites is common. Recovery can vary, and a bulge sometimes develops at the donor site, which is why lifting is reintroduced carefully.
This is a substantial operation with two surgical sites, so risks at both are explained before you give consent.
Two sites need looking after at home, and the routines are explained before discharge.
Other muscles compensate over time, and the donor site is repaired and usually reinforced. Most people return to normal daily activity.
Local tissue is often irradiated or scarred. Bringing healthy tissue from the abdomen is what makes healing possible in those situations.
A vertical scar remains on the abdomen, and the paddle sits mostly hidden in the perineum. Ordinary clothing usually conceals both areas.
Two sites are healing at once, so activity is reintroduced more gradually and reviews check the abdominal repair as well as the flap.
Combined pelvic and abdominal work needs joint planning and clear explanation, so the approach here is unhurried and a written estimate is provided before admission.
Because this flap is usually part of a larger pelvic operation, cost depends on the extent of that surgery, the mesh used at the donor site, intensive care needs and the length of stay. A written estimate is prepared after assessment, separating surgeon and anaesthesia fees, theatre charges, implants, ward stay and review visits, with help offered for insurance claims.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →An estimate is written after assessment, since the flap is usually combined with major pelvic surgery. Theatre time, mesh, ward or intensive care stay and review visits are all listed clearly before admission.
The abdomen usually lies outside the irradiated field, so its tissue heals reliably. The muscle also provides bulk to fill a deep pelvic space, which thin local skin simply cannot do.
Some weakness on that side is expected, so the donor area is repaired and often reinforced with mesh. Lifting is reintroduced gradually, and the site is checked at every review for bulging.
Yes. The side used for the flap is agreed with the cancer team before surgery, so the stoma site is preserved. Marking is done in advance while you are standing.
Stays are usually prolonged, because two surgical sites are healing and pelvic surgery itself takes time to recover from. Progress is reviewed daily. Recovery can vary between patients.
Sitting starts in short spells and builds up over the weeks that follow, guided by how the perineal wound looks. Cushions and position changes help, and progress is checked at review.
Good nutrition, controlled blood sugars, stopping tobacco and gentle fitness work all improve healing. Preparation is discussed at the first consultation, along with what to expect afterwards.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
