Filling the Depths: Innovative Vertical Rectus Abdominis Myocutaneous (VRAM) Flap Reconstruction in a Complex Deep Tissue Pressure Injury

Deep tissue injuries (DTIs) pose significant reconstructive challenges, particularly when involving extensive soft tissue loss and exposure of vital structures. We report a case of a 69-year-old male with multiple comorbidities who developed a complex, full-thickness trochanteric wound following prolonged immobilization after a cardiac event. The injury, characterized by a 19 x 9 cm defect with compromised surrounding tissues - including the tensor fascia - precluded the use of conventional local flaps. Given the size and depth of the defect, a pedicled vertical rectus abdominis myocutaneous (VRAM) flap was selected for its robust vascularity, versatility, and ability to provide ample soft tissue bulk. Complete healing was observed at the six-month follow-up visit with no evidence of abdominal wall compromise or functional deficit. This case illustrates that the VRAM flap is a reliable and effective option for the reconstruction of large, complex DTIs in the proximal lower extremity, particularly when local flap options are compromised.