Pelvic, Vaginal, and Perineal Reconstruction in Radical Pelvic Surgery

Special Role of Plastic Surgery in Approaches to Complex Reoperative Pelvic Operations

“…The rectus abdominis muscle is useful for closure of soft tissue or bone defects of lhe upper pelvis. For defects of the lower pelvis, the graci lis or rectus femoris muscles may be more suited [4].…”

“…If necessary, the proxi IVIvie Reoperation Dip Sur* 1996:13:38-44 43 mal muscle attachment can be divided to increase mobili ty [8]. The gracilis muscle myocutaneous donor site can usually be closed directly or as a V-Y repair [4], There are numerous reports describing the use of the gracilis muscle to close postoperative pelvic defects fol lowing surgery for both benign and malignant disease [1,2,[9][10][11][12][13][14]. The gracilis muscle has been used to reinforce the repair of urethroperineal, urethrocutaneous, vesicocutaneous, and rectovaginal fistulae [3,7,[15][16][17], In men, due to the absence of an interposed structure such as a vagina between the rectum and bladder, and in the absence of labial fibrofatty tissue, which can be used to repair fistulae in women, rectourethral fistulae are both more common and more difficult to repair [18], Fistulae may recur following repair because of contact between the fistula closure site and external suture lines [19], In one series, the gracilis or rectus muscles were used to success fully close more than 75% of rectovaginal and vesicovagi nal fistulas, or combinations thereof [17], Plastic surgery principles of myocutaneous or muscle flap transposition are valuable assets to the general or colon and rectal surgeon performing pelvic surgery.…”

Exenterative pelvic surgery

“…Often, the thickness and length of the omental tissue will fill most of the inner pelvis. Other methods that can be used include placement of absorbable or permanent mesh at the pelvic inlet, pedicle myocutaneous flaps, or free flaps using microvascular reconstruction [46].…”

“…Detailed analysis of complication rates related to the various forms of urinary diversion is beyond the scope of this article, and the reader is referred to excellent work reported by others [45][46][47].…”

Vaginal Reconstruction Using a Modified Rectus Abdominis Musculocutaneous Flap in Pelvic Cancer Surgery

“…4 Vaginal reconstruction, using a rectus abdominis musculocutaneous flap, is a well-known technique and was first described by G. R. Tobin in 1988. [5][6][7] Rectus abdominis flaps can be used in groin, pelvic, perineal, and vulval reconstructive surgery. For many surgeons, it is the flap of choice to be used in vaginal reconstruction after radical pelvic oncological surgery.…”