Incisional and parastomal hernias after harvesting of Vertical Rectus Abdominis Myocutaneous (VRAM) flaps: incidence, treatment options and outcomes
- 01.12.2025
- Review
Erschienen in:
- Verfasst von
- Camille Vervaet
- Camille Maeyaert
- Mathias Allaeys
- Frederik Berrevoet
- Hasan H. Eker
- Gabrielle H. van Ramshorst
- Erschienen in
- Hernia | Ausgabe 1/2025
Abstract
Aim
The Vertical Rectus Abdominis Myocutaneous (VRAM) flap is a versatile reconstructive technique but is associated with donor-site morbidity, including incisional hernia (IH) and parastomal hernia (PSH). Our aim was to assess the incidence, treatment options and outcomes of IH and PSH following VRAM flap harvest.
Method
A systematic search was conducted in PubMed, Embase and Scopus (to June 2024) using predefined terms. Studies with at least 10 participants and a follow-up of minimum one year were included. Two reviewers independently performed study selection, data extraction, quality of evidence (GRADE) and risk of bias (ROBINS-I, RoB-2). Primary outcomes were IH and PSH incidence.
Results
24 studies (2200 patients) were included (19 retrospective cohorts, 3 case series, 2 randomized controlled trials). IH was reported in 10.2% (226/2200) and PSH in 19.2% (219/1143) of patients over a mean follow-up of 31 months (range: 12–66). Studies focused on prophylactic techniques included robotic harvesting (n = 1), fascia-sparing harvesting (n = 5), component separation (n = 6) and mesh-assisted closure (n = 16). Hernia repair involved mesh (n = 3) and primary suture (n = 1).
Conclusion
Despite advances in prophylactic techniques for hernia prevention, significant challenges remain, including high heterogeneity in clinical diagnosis, follow-up duration, and surgical techniques. While some methods, such as fascia-sparing approaches, component separation, and mesh reinforcement show promising outcomes in reducing IH and PSH incidence, a lack of comparative studies prevents reaching a clear consensus. Future research should focus on larger scale studies and expert opinions to develop clinical recommendations for hernia prophylaxis and repair.
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- Titel
- Incisional and parastomal hernias after harvesting of Vertical Rectus Abdominis Myocutaneous (VRAM) flaps: incidence, treatment options and outcomes
- Verfasst von
-
Camille Vervaet
Camille Maeyaert
Mathias Allaeys
Frederik Berrevoet
Hasan H. Eker
Gabrielle H. van Ramshorst
- Publikationsdatum
- 01.12.2025
- Verlag
- Springer Paris
- Erschienen in
-
Hernia / Ausgabe 1/2025
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204 - DOI
- https://doi.org/10.1007/s10029-025-03406-8
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