Gracilis myocutaneous vaginal reconstruction concurrent with total pelvic exenteration

Modified vertical rectus abdominis myocutaneous flap vaginal reconstruction: An analysis of surgical outcomes

“…The incidence of flap necrosis, either complete or partial, compares favorably with previously reported rates of RAM flap necrosis of 9-19% [7] and rates of gracilis flap necrosis of 13-37% [10, 11]. Similarly, vaginal stenosis was less common than previously published ranges of 14-19% [12, 13].…”

“…In addition to the psychosocial benefits, myocutaneous grafts improve wound healing by filling pelvic dead space and reducing the incidence of pelvic abscess and intestinal fistulae. In the past, the gracilis myocutaneous flap was used most commonly but carried the disadvantage of additional unsightly scarring on the thighs, increased risk of prolapse, as well as flap necrosis due to vascular compromise [10, 11, 14]. Rectus abdominis myocutaneous flaps have more recently come into favor for vaginal reconstruction as they have low rates of necrosis and vaginal stenosis, do not require the use of vaginal dilators, utilize a single incision, and are facile flaps.…”

Options for repair of rectus abdominis myocutaneous perineal/vaginal flap prolapse: A case series

“…Prolapse of the gracilis myocutaneous flap used for vaginal reconstruction has been documented (Copeland et al, 1989; Barnhill et al, 1985; Delmore et al, 1987). Modifications in surgical technique including decreasing the flap size, suturing the neovagina to the levator and retropubic fascia, and sacrificing the dominant neurovascular pedicle to provide additional mobilization have been shown to decrease the rate of gracilis flap prolapse (Copeland et al, 1989). Barnhill et al reported the repair of gracilis myocutaneous neovagina prolapse after pelvic exenteration using sacrospinous ligament suspension (Barnhill et al, 1985).…”

Laterally Extended Endopelvic Resection (Leer) and Reconstructive Techniques for Treatment of Locally Advanced Cervix Cancer: A Case Report

“…However, gracilis flaps are associated with a high failure rate (11-37%) due to vascular compromise; leave unsightly scars on the medial thighs; are frequently too large and bulky to use when the perineal body and anus are preserved [10,11]. In our patient we prefered a vertical myocutaneous flap to create the neovagina and one year after the intervention, the patient has none of these complications and it has achieved an increase in its quality of life, although a long-term monitoring is necessary to assess late complications.…”