Gluteal and Sacral Defect Reconstruction Using a Transabdominal Oblique Rectus Abdominis Myocutaneous Flap: Literature Review.

Abstract

Reconstruction of large gluteal and sacral defects after tumor resection is challenging, especially in patients with previous surgery or radiation. Local flaps may be unreliable in such cases. The vertical and oblique rectus abdominis myocutaneous (ORAM) flaps provide well-vascularized tissue with enough reach for coverage. The transabdominal route is also used for deep or high gluteal defects. This article aims to present a complex case of gluteal defect reconstruction using a transabdominal ORAM flap and to review the relevant literature on similar techniques. A 28-year-old man with recurrent left gluteal soft-tissue sarcoma, previously treated with surgery, chemotherapy, and radiotherapy, presented with a recurrence. After evaluation, he underwent wide-margin tumor resection with reconstruction using a transabdominal ORAM flap. The colorectal team created a tunnel through the abdominal floor, and the flap was passed via partial iliac wing bone resection to cover the gluteal defect. The plastic, orthopedic, and colorectal teams worked together to deliver and inset the flap without tension. The donor site was closed with mesh reinforcement, and drains were placed in both the abdomen and gluteal region. Postoperatively, he developed a minor hematoma that was drained successfully. At 4 months, all wounds had healed completely, with no evidence of hernia, infection, or recurrence. The transabdominal vertical rectus abdominis myocutaneous and ORAM flaps are dependable options for gluteal and sacral reconstruction, providing strong coverage and low complication rates. It is especially useful when local tissue is scarred or irradiated, and multidisciplinary collaboration ensures safe and effective results.