Complications of the 'Enhanced Recovery after Surgery Programme' following pedicled vertical rectus abdominis myocutaneous flap in perineum reconstruction.

The enhanced recovery programme, pioneered in the colorectal surgical setting, aims to reduce the length of inpatient stay following a procedure and was started in our trust in 2006. We present the case of a patient who underwent perineal reconstruction with a pedicled vertical rectus abdominis myocutaneous (VRAM) who subsequently developed bladder outflow obstruction compromising flap viability. As a result of our experience we are in the process of producing new guidelines that advocate patients undergoing a VRAM flap for perineal reconstruction should be exempt from aspects of the enhanced recovery programme, in particular early removal of the catheter should be avoided.