Reconstruction of Acquired Defects of the Vagina and Perineum

Salgado, Christopher J.; Chim, Harvey; Skowronski, Piotr Pawel; Oeltjen, John C.; M, Rodriguez; Mardini, Samir

doi:10.1055/s-0031-1281485

Cited by 19 publications

(10 citation statements)

References 42 publications

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“…In addition, both these prolonged options need to be carried out in the lithotomy position requiring intra-operative change of position. The Singapore flap as well as the Gracilis flap have reported flap failure loss of up to 15% 9 , 10 . Superior and Inferior Gluteal artery perforator-based fasciocutaneous transposition flap was described to reconstruct perineal and partial vaginal wall defects 11 .…”

Section: Discussionmentioning

confidence: 99%

Perineal Turn over Perforator Flap: A Novel Surgical Technique for Combined Perineal and Posterior Vaginal Wall Reconstruction

Moura

Chasapi

Mitchell

et al. 2021

wjps

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Extralevator Abdominoperineal Excision (ELAPE) and Abdominoperineal Resection create complex perineal defects made more challenging when combined with additional resection of the posterior vaginal wall. This composite defect requires the restoration of a functional vagina, in addition to the obliteration of the large perineal dead space, a need to reduce donor site, and perineal wound morbidity. Previously described fasciocutaneous and myocutaneous flaps for such defects are associated with long operations requiring intra-operative mobilization and are linked to post-operative complications including herniation, evisceration, flap loss, donor site morbidity and poor cosmetic outcome, amongst other issues. Herein we describe the case of a 60-year-old female patient that underwent combined ELAPE and posterior vaginectomy for anal squamous cell carcinoma. This complex defect was reconstructed using an extended version of the Perineal Turn-Over (PTO) flap based on the Internal Pudendal artery perforator.

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Section: Discussionmentioning

confidence: 99%

Perineal Turn over Perforator Flap: A Novel Surgical Technique for Combined Perineal and Posterior Vaginal Wall Reconstruction

Moura

Chasapi

Mitchell

et al. 2021

wjps

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“…Since the vulvar region has a flexible skin, many defects can be primarily closed after large resections (1,10). The number of cases requiring reconstruction in vulvar oncological resections constitutes approximately 3% of all cases (10).…”

Section: Discussionmentioning

confidence: 99%

“…Vulva and perineum defects most commonly occur due to curative surgical resections. Less commonly, it can also be caused by trauma and necrotic soft tissue infections (1). The most common histological type in vulvar cancers is squamous cell carcinoma associated with the human papilloma virus (HPV).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

Aksan

Karateke

Uzuneyüpoğlu

et al. 2021

Düzce Tıp Fakültesi Dergisi

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Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum. Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated. Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm 2 . Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term. Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients.

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“…Due to the size of such defects and poor general status of the oncological patient, the use of pedicled flaps emerged as the preferred reconstruction method. For large volume defects, occurring after pelvic exenteration, bulky flaps such as vertical rectus abdominis muscle (VRAM), gracilis, omentum are preferred, to fill the dead space and separate the abdominal contents from the pelvic cavity [6,21]. For superficial and limited volume defects fasciocutaneous flaps like gluteal, lotus, IGAP are preferred [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Various reconstruction methods were described: vacuum-assisted closure (VAC) [1], skin grafts [2], skin substitutes [3], pedicled [4] or free flaps [5]. In the case of defects following oncologic surgery, flaps are the reconstructive method of choice because of defect size, the need to separate intraperitoneal contents from perineum and fill/obliterate dead space, and frequent subsequent radiotherapy [6].…”

Section: Introductionmentioning

confidence: 99%

Bilateral V-Y advancement gluteal fold flaps following vulvo-vaginal melanoma resection

Pieptu¹,

Mihai²,

Gheţu³

et al. 2015

Arch Clin Cases

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The soft tissue defects of the anterior perineum can be caused by tumour excision, trauma, burns, Fournier's gangrene and genital mutilation. Various reconstruction methods were described: vacuum-assisted closure, skin grafts and skin substitutes, pedicled or free flaps. In the case of defects following oncologic surgery, flaps are the reconstructive method of choice. We present the case of a 65 year-old woman diagnosed with stage III A vulvovaginal melanoma affecting also the distal urethra. Radical vulvectomy and en-bloc excision of the anterior third of the vagina and distal urethra, along with bilateral inguinal lymphadenectomy was performed. The resulting defect was covered with bilateral V-Y advancement gluteal fold flaps. A local vaginal recurrence appeared 18 months after surgery and was safely removed. The patient followed chemotherapy with Dacarbazine. The gluteal fold flap offered good defect coverage and survived completely. Follow-up period was two years without distant metastases. Functional result was excellent, urinary function being normal and patient satisfaction high. Due to the gluteal flap's advantages (appropriate thickness, good vascularity, minimal donor site morbidity, and same operative field allowing for shorter operating time), reconstruction of the anterior perineum after oncological resection with bilateral V-Y advancement gluteal flaps is a viable solution.

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Reconstruction of Acquired Defects of the Vagina and Perineum

Cited by 19 publications

References 42 publications

Perineal Turn over Perforator Flap: A Novel Surgical Technique for Combined Perineal and Posterior Vaginal Wall Reconstruction

Perineal Turn over Perforator Flap: A Novel Surgical Technique for Combined Perineal and Posterior Vaginal Wall Reconstruction

Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

Bilateral V-Y advancement gluteal fold flaps following vulvo-vaginal melanoma resection

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