Transperitoneal Spiralized Rectus Abdominis Muscle Flap for Total Vaginal Reconstruction.

Total vaginal reconstruction remains a significant surgical challenge in patients with altered pelvic anatomy due to oncologic resection, radiation, trauma, or congenital absence. Traditional flap options often present limitations in terms of bulk, reach and donor site morbidity. We present a novel technique utilizing the spiralized rectus abdominis muscle (SRAM) flap for total vaginal reconstruction. A 45-year-old female patient underwent successful vaginal reconstruction using the SRAM flap following oncologic resection. The rectus muscle is spiralized along its longitudinal axis to create an elongated, pliable, well-vascularized neovaginal canal. The procedure was completed without intraoperative or postoperative complications. At 1-year follow-up, the neovagina remained patent and functional, with patient-reported satisfaction and no significant donor site complications. The SRAM flap represents a promising alternative for total vaginal reconstruction, offering enhanced pliability, reliable perfusion, and minimal abdominal wall morbidity. Further studies are needed to validate its long-term outcomes and broader applicability.