Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap

Kaartinen, Ilkka; Vuento, Maarit; Hyöty, Marja; Kallio, Jukka; Kuokkanen, Hannu

doi:10.1016/j.bjps.2014.08.059

Cited by 25 publications

(22 citation statements)

References 19 publications

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“…Several types of pelvic oncologic resections may require complete or partial removal of the vagina . The consequent loss of sexual function can be devastating, especially among younger patients, becoming an important psychological factor for women.…”

Section: Resultsmentioning

confidence: 99%

“…Several surgical techniques have been described for vaginal reconstruction, such as the use of a skin graft, rectosigmoid intestinal flap, and myocutaneous flaps . Historically, the results with the use of skin grafts are discouraging mainly for cases submitted to previous radiotherapy …”

Section: Resultsmentioning

confidence: 99%

“…74 Several surgical techniques have been described for vaginal reconstruction, such as the use of a skin graft, rectosigmoid intestinal flap, and myocutaneous flaps. 23,33,[71][72][73][74][75][76][77][78]82,83 Historically, the results with the use of skin grafts are discouraging mainly for cases submitted to previous radiotherapy. 84 The uses of myocutaneous flaps with rectus abdominis or gracilis muscle are the most frequently used.…”

Section: Use Of Ureteral Cathetermentioning

confidence: 99%

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Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Use Of Ureteral Cathetermentioning

confidence: 99%

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Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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“…Für die Rekonstruktion größerer Defekte ist die Gracilisplastik nicht geeignet, nach totaler Beckenexenteration kann der Muskel aber, ggf. zusätzlich zu anderen Lappenplastiken, zur Rekonstruktion der Vagina verwendet werden [29].…”

Section: M-gracilis-lappenunclassified

Plastische Deckung ausgedehnter Defekte nach exenterativen Eingriffen im Becken

et al. 2015

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Extended resections of pelvic malignancies, especially in cases of recurrent malignancies, result in the formation of large tissue defects in the region of the pelvic floor and perineum, which are difficult to deal with. Both after extra levator rectal excision and pelvic exenteration, wound healing deficiencies and local infections of the perineal wound are frequent. Primary closure is often impossible due to a lack of tissue substance after resection and an additional previous radiotherapy in most cases. This can result in poor or non-healing wounds, a consecutive need of complex care and an increased risk of secondary problems including tumour recurrences. A permanent wound closure of good quality can therefore only be achieved by plastic surgery. This can be done by local or distant muscle flaps with or without skin, for example, the gluteus maximus flap, the vertical rectus abdominis muscle flap (VRAM) or free flaps such as the latissimus dorsi flap.

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“…It does not lead to functional deficits, complicate the abdominal stomas, or weaken the abdominal wall. It reduces the length of operation and, moreover, donor defect and scars are minimal [30,31].…”

Section: Quality Of Lifementioning

confidence: 99%

Pelvic Exenteration for the Management of Pelvic Malignancies

Paramythiotis¹,

Kofina²,

AntoniosMichalopoulos³

2015

Approaches to Hysterectomy

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Pelvic exenteration is a surgical procedure first described by Brunschwig in as a curative or palliative treatment for pelvic and perineal tumors. It is actually a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In patients with recurrent cervical and vaginal malignancy, it is associated with a -year survival of more than %. In spite of advances in surgical management, consequences such as stomas, are still frequently unavoidable for radical tumor excision. Most candidates for this procedure have been diagnosed with recurrent cervical cancer that has previously been treated with surgery and radiation, or radiation alone. Complications of pelvic exenteration are more severe than those of standard resection of a colorectal carcinoma, so it is not commonly performed, including wound infection, wound dehiscence also described as burst abdomen the creation of fistulae perineal-fecal, uretero-vaginal, between conduit and perineal wound , urinary tract infections, perineal hernias and intestinal obstruction. Patients need to be carefully selected and counseled about risks and long-term issues related to the surgery. A comprehensive evaluation is required in order to exclude unresectable or metastatic disease. Evolution of the technique through laparoscopy and minimally invasive surgery may result in a reduction of morbidity and mortality.

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Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap

Cited by 25 publications

References 19 publications

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Plastische Deckung ausgedehnter Defekte nach exenterativen Eingriffen im Becken

Pelvic Exenteration for the Management of Pelvic Malignancies

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