Summary: Wide resection of advanced recurrent high-grade soft tissue sarcomas often leaves large defects that are challenging to reconstruct. The options for defect closure vary. A free vertical rectus abdominis myocutaneous (VRAM) flap could be an alternative for closing a significantly large defect, particularly for recurrence after wide resection using a pedicled flap. We present the case of a 79-year-old man with recurrent soft tissue sarcoma in the right upper arm after wide resection using a pedicled latissimus dorsi flap, which was treated with wide resection and subsequent defect closure using a free VRAM flap. The VRAM flap was initially often used to reconstruct the chest and abdominal walls; therefore, there have been few reported uses for upper arm defects. The repair site defect was viable even with a less aesthetic donor site, and all defects were closed without any signs of infection. The free VRAM flap is a promising option for large defect closure in the upper arm region, particularly after wide resection in cases where a pedicled flap is unavailable.
Iwai et al. (Mon,) studied this question.