A Prospective Assessment of Surgical Risk Factors in 114 Gluteal Fold Flap Reconstructions After Oncological Vulvoperineal Resection

Lange, Maurits; Hage, J. Joris; Beurden, Marc van

doi:10.1097/sap.0000000000000964

Cited by 9 publications

(17 citation statements)

References 23 publications

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“…Lange and colleagues published the largest series of gluteal flaps in 2017, introducing two different methods for flap transfer, V-Y advancement flap and rotation flap. 34 With their rich experience, V-Y advancement was more recommended with less complications. Its use also presented with significantly more complications in patients with previous radiotherapy and a tendency of higher complication rate in cancer recurrence cases, bilateral defects, and rotation flap design.…”

Section: Reconstructive Methods For Vulva and Soft Tissue Defectsmentioning

confidence: 99%

“…Besides more complications, as pedicle rotation flaps, however, they do not completely eliminate tension upon closure given their need to still be rotated into the defect. 34 The best known myocutaneous flap is the gracilis myocutaneous flap with the medical circumflex femoral artery as its vascular pedicle. 35 This method is not without its own morbidity, especially stemming from necrosis at the distal skin paddle.…”

Section: Reconstructive Methods For Vulva and Soft Tissue Defectsmentioning

confidence: 99%

“…However, myocutaneous flaps remain a preferred choice when a larger defect or a dead space presents (►Table 4). [20][21][22]24,34, By choosing a perforator flap, we also preserve the myocutaneous flap for future usage. Restoration of the perineum appearance should be considered equally important and be achieved whenever possible.…”

Section: Redefining the Reconstructive Ladder With Elevator Approach In Vulvar-perineum Reconstructionmentioning

confidence: 99%

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Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

Elia

Chang

et al. 2021

J Reconstr Microsurg

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Background Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Methods A retrospective review was conducted of all patients who underwent vulvar–perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. Results Thirty-three patients underwent 55 soft tissue reconstructions for vulvar–perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. Conclusion In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.

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Section: Reconstructive Methods For Vulva and Soft Tissue Defectsmentioning

confidence: 99%

Section: Reconstructive Methods For Vulva and Soft Tissue Defectsmentioning

confidence: 99%

Section: Redefining the Reconstructive Ladder With Elevator Approach In Vulvar-perineum Reconstructionmentioning

confidence: 99%

See 1 more Smart Citation

Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

Elia

Chang

et al. 2021

J Reconstr Microsurg

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“…Larger rotational flaps have been used for larger ment flap has been reported from 14% to 60%. 6,12,15 Wound infection, partial dehiscence, partial flap necrosis and deviation of the urinary stream were the main early complications observed by various authors. Six percent of patients had to be returned to the operating theatre for abscess drainage according to one study.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of small and moderate defects of the perineum

Ioannidis¹

2022

HJOG

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Introduction: Resection of benign, premalignant or malignant lesions of the perineum result in tissue defects, which are preferably reconstructed with a flap rather than closed primarily or covered with a skin graft. Numerous skin flaps have been utilized with varying success rates. Patients and Methods: The charts of all female patients with perineal defects operated by the author during the past five years were retrospectively reviewed. Two flaps were used: a modified Limberg (rhomboid rotation) flap for small defects and a bilateral medial thigh V-Y advancement flap for moderate defects. Results: Seven patients were found. Two patients were operated because of benign pathology and five because of a pre- or malignant lesion. Two small and five moderate defects resulted after the resection. All flaps survived and there were no major complications. All patients had sensation on the flap postoperatively and were pleased with the functional and aesthetic result. Conclusion: Small perineal defects are satisfactorily restored with a rotation rhomboid flap, whereas moderate sized defects are best reconstructed with bilateral medial thigh V-Y flaps.

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“…Previous radiation and a rotational flap rather than advancement flap were found to be risk factors for complications. 42 In a review of the literature by Wills et al, 9 only 9 articles were identified from 1965 to 2012 that assessed complications arising from vulvar surgery for vulvar cancer. Regarding wound complications, they reported a 9% to 58% rate among all 9 studies, citing obesity, tumor size and location, age, diabetes, smoking, and prior radiation as risk factors for wound breakdown.…”

Section: Discussionmentioning

confidence: 99%

Trends and Complications of Vulvar Reconstruction After Vulvectomy

Martin

Stewart

Girithara-Gopalan

et al. 2018

International Journal of Gynecological Cancer

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A Prospective Assessment of Surgical Risk Factors in 114 Gluteal Fold Flap Reconstructions After Oncological Vulvoperineal Resection

Abstract: We identified surgical risk factors for gluteal fold flap use after oncological vulvoperineal resection. These observations may potentially allow for more favorable future surgical outcomes by adaption of selection of patients or procedure.

Cited by 9 publications

References 23 publications

Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

Reconstruction of small and moderate defects of the perineum

Trends and Complications of Vulvar Reconstruction After Vulvectomy

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