Postablative reconstruction of vulvar defects with local fasciocutaneous flaps and superficial fascial system repair

Al-Benna, Sammy; Tzakas, Elias

doi:10.1007/s00404-012-2262-1

Cited by 12 publications

(18 citation statements)

References 22 publications

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“…Defects in the inguinal region or lesions in the anterior section of the vulva would be typical indications for taking grafts from the musculus tensor fasciae latae [22]. The gracilis flap is probably the best known and most commonly used of the myocutaneous flaps [20]: such flaps may be up to 30 cm in length, and their apical sections are vulnerable to the development of Updates Surg necroses. Larger group of patients treated using gracilis flaps also revealed an uneven degree of success so this method is not used anymore.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

“…Larger diseases require regional flaps created by mobilising a nearby island of tissue (e.g., the gluteal fold flap), or distant pedicled flaps obtained from the thigh (gracilis) or abdomen (TRAM, transverse rectus abdominis muscle). Vulvar reconstruction with an immediate single-staged sensate flap that provides reliable and durable coverage is the ideal choice [20]. Postablative reconstruction of vulvar defects has generally used local flaps, such as pudendal thigh flaps, gluteal fold flaps or V-Y flaps.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

“…Plastic surgery operations allow to implement therapeutic measures in accordance with the stage of tumour development [3]. Post-ablative reconstruction of oncologic vulvar defects could be challenging because of scanty local tissue: it should not interfere with the important functions of micturition, reproduction and defecation [20]. Reconstruction of the vulva is important for functional cosmetic and psychological reasons.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

“…Reconstruction of the vulva is important for functional cosmetic and psychological reasons. The wide range of reconstructive options includes: skin grafts, skin flaps, fasciocutaneous flaps, myocutaneous flaps [20]. Skin grafting is not usually suitable according to the nature of the area and interference with function and cosmesis.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

“…Vulvar reconstruction with myocutaneous flaps has numerous disadvantages when compared with the fasciocutaneous flaps: more difficult preoperative management, more difficult operation, greater extension of scars into the donor site, more changes of position during operation, necessity of a greater ability by the surgeon and more difficult application in older patients. Moreover, it involves the sacrifice of important functional muscles [20]. Fasciocutaneous flaps represent an excellent tool for vulvar reconstructions: the most used ones are mobilised from the perineal region due to their high vascularisation and wide mobility: lotus petal flap, VY flap from the pubic region, VY advanced flap from the gluteal fold and from the medial thigh and pudendal thigh flap.…”

Section: Reconstructive Surgerymentioning

confidence: 99%

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Recent trends in surgical and reconstructive management of vulvar cancer: review of literature

et al. 2015

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Vulvar cancer (VC) is a rare disease. The most common histologic type is squamous-cell carcinoma. VC could be divided into two types: type one, commonly associated with HPV infection, occurs in young women and type two, associated with non-neoplastic lesions that usually occurs in older women. Previously VC was often treated with radical Vulvectomy. Today update in diagnostic and surgery technique, capable to identify early stages of disease and adaptation in surgery procedures, according to the stage of disease, age of patients and possible physical and psychological morbidity consequence, allow using less radical surgery approaches. That has led to decrease therapy-associated morbidity while preserving oncologic safety and improving psychosexual outcomes. Finally, several surgical treatments are available in case of VC and, despite radical surgery is often required, less radical surgery associated with reconstructive plastic surgery decreases some of short- and long-term associated complications.

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Section: Reconstructive Surgerymentioning

confidence: 99%

Section: Reconstructive Surgerymentioning

confidence: 99%

Section: Reconstructive Surgerymentioning

confidence: 99%

Section: Reconstructive Surgerymentioning

confidence: 99%

Section: Reconstructive Surgerymentioning

confidence: 99%

See 3 more Smart Citations

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature

et al. 2015

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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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Outcomes Analysis of Gynecologic Oncologic Reconstruction

Block

Hartmann

King

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Defects resulting from gynecologic oncology resections can range from small external defects to total exenterations, requiring complex pelvic reconstruction. We aim to investigate the patient and surgical factors that influence complication rates, reoperation rates, and length of stay. We hypothesize that this patient cohort will have high complication and reoperation rates that are likely most affected by their medical and extirpative surgery factors, with less direct impact from their reconstructive surgery procedures. Methods: All cases of reconstruction following resection of a gynecological oncology tumor at the University of Wisconsin Hospital over the last 14 years were reviewed. Forty-three patients were identified who required 66 flaps for reconstruction. Results: Mean follow-up period was 19 months. Overall complication rate was 65% and reoperation rate was 33%. Plastic surgery flap-specific complication and reoperation rates were 47% and 19%, respectively, and were not significantly associated with any patient risk factors. Flap reconstruction subtype was not associated with time to complete healing, complication rate, or reoperation. Prior chemotherapy was significantly correlated with increased rate of overall complication ( P = 0.0253) and reoperation ( P = 0.0448), but prior radiation was not. Mean hospital stay was 11 days (SD ± 9 d). Factors found to be significantly associated with an increase in hospitalization length were increasing number of comorbidities ( P = 0.021), exenteration defects ( P = 0.0122), myocutaneous flap reconstruction ( P = 0.0003), radiation ( P = 0.0004), and chemotherapy P = 0.0035). Conclusion: This patient cohort has an overall high complication and reoperation rate; however, increasingly complex reconstruction is not associated with significant differences in complication rates or reoperation.

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Postablative reconstruction of vulvar defects with local fasciocutaneous flaps and superficial fascial system repair

Abstract: Local fasciocutaneous flaps with superficial fascial system repair provide excellent design flexibility and can be designed and tailored to reconstruct postablative vulvar defects with good outcomes and minimal morbidity.

Cited by 12 publications

References 22 publications

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature

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

Outcomes Analysis of Gynecologic Oncologic Reconstruction

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