Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series

Ferron, Gwénaël; Gangloff, D.; Querleu, Denis; Frigenza, M.; Torrent, Juan José; Picaud, Laetitia; Gladieff, Laurence; Delannes, M.; Mery-Lamarche, Eliane; Boulet, Bérénice; Balagué, Gisèle; Martinez, Alejandra

doi:10.1016/j.ygyno.2015.06.031

Cited by 22 publications

(14 citation statements)

References 32 publications

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“…However, there is no clear evidence that use of abdominal flap would increase abdominal herniation risk [15,28] Second, harvesting the TMG flaps and reconstruction of the pelvic floor can be performed while the urologist performs urinary diversion. Our mean surgical time of 428 min was comparable to the 335e725 min reported for reconstructions with abdominal-based flaps in previously published series [17,29]. There are no prospective studies comparing thigh or abdominal based flaps for pelvic floor and vaginal reconstruction.…”

Section: Discussionsupporting

confidence: 71%

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Kiiski

Räikkönen

Vuento

et al. 2019

European Journal of Surgical Oncology

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Introduction: Pelvic exenteration (PE) is the only curative treatment for certain locally advanced intrapelvic malignancies. PE has high morbidity, and optimal reconstruction of the pelvic floor remains undetermined. Materials and methods: A retrospective chart review was performed at a tertiary university center to assess the surgical and oncological outcomes of 39 PE procedures over a 12-year period. The majority of patients (n ¼ 25) underwent transverse musculocutaneous gracilis (TMG) flap reconstruction for pelvic floor reconstruction. Results: The 1-and 5-year overall survival (OS) was 72% (95%CI 58%e86%) and 48% (95%CI 31%e65%), respectively. In multivariate analysis, lymph node metastasis (HR 3.070, p ¼ 0.024) and positive surgical margins (HR 3.928, p ¼ 0.009) were risk factors for OS. In this population, 71.8% of the patients had at least one complication. The complication rate was 65.4% and 84.6% for patients with versus without flap reconstruction, respectively (p ¼ 0.191). The length of stay was longer for patients with a major complication 16,0 ± 5,9 days vs. 29,4 ± 14,8 days, p ¼ 0,001, but complications did not affect OS. Conclusion: For selected patients, PE is a curative option for locally advanced, residual, or recurrent intrapelvic tumors. Pelvic floor and vulvovaginal defects can reliably be reconstructed using TMG flaps. TMG flaps are favored in our institution over abdominal-based flaps because the donor site morbidity is reasonable and TMG does not interfere with enterostomy.

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Section: Discussionsupporting

confidence: 71%

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Kiiski

Räikkönen

Vuento

et al. 2019

European Journal of Surgical Oncology

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“…The complications derived from the empty space left in the pelvis after removing the pelvic organs are known as 'empty pelvic syndrome' or 'pelvic burn syndrome', which includes the risk of fistula, pelvic collection, chronic infection, osteomyelitis, and organ prolapse. 53 To reduce these complications, it is highly recommended to perform during the urinary reconstruction an omental J-flap, perforator flap, 54 or musculocutaneous flap, 55 to restore pelvic anatomy and also to provide healthy autologous tissues to fill and restore the pelvis. In addition, such tissues may be employed to cover bowel and urinary anastomoses, decreasing the risk of fistula, abscess, intestinal obstruction, and bowel perforation.…”

Section: Early Complicationsmentioning

confidence: 99%

Urinary diversion after pelvic exenteration for gynecologic malignancies

Martínez-Gómez

Ángeles

Martinez

et al. 2020

Int J Gynecol Cancer

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Pelvic exenteration combines multiple organ resections and functional reconstruction. Many techniques have been described for urinary reconstruction, although only a few are routinely used. The aim of this review is to focus beyond the technical aspects and the advantages and disadvantages of each technique, and to include a critical analysis of continent techniques in the gynecologic and urologic literature. Selecting a technique for urinary reconstruction must take into account the constraints entailed by the natural history of the disease, patient characteristics, healthcare institution, and surgeon experience. In gynecologic oncology, the Bricker ileal conduit is the most commonly employed diversion, followed by the self-catheterizable pouch and orthotopic bladder replacement. Continent and non-continent diversions present similar immediate and long-term complication rates, including lower tract urinary infections and pyelonephritis (5–50%), ureteral stricture (3–27%), urolithiasis (5–25%), urinary fistula (5%), and more rarely, vitamin B12 deficiency and metabolic acidosis. Urinary incontinence for the ileal orthotopic neobladder (50%), stoma-related complications for the Bricker ileal conduit (24%), difficulty with self-catheterization (18%) for the continent pouch, and induction of secondary malignancy for the ureterosigmoidostomy (3%) are the most relevant technique-related complications following urinary diversion. The self-catheterizable pouch and orthotopic bladder require a longer learning curve from the surgical team and demand adaptation from the patient compared with the ileal conduit. Quality of life between different techniques remains controversial, although it would seem that young patients may benefit from continent diversions. We consider that centralization of pelvic exenteration in referral centers is crucial to optimize the oncologic and functional outcomes of complex ablative reconstructive surgery.

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“…A composite reconstruction is also possible – for example, using a biological mesh for the pelvic floor and a pedicled flap for the perianal/vaginal defect, thus sparing the rectus abdominis. Vaginal reconstruction with the pedicled vertical deep inferior epigastric perforator flap may be technically easier, and has a reduced likelihood of muscle atrophy, but experience with this flap is limited in exenterative surgery …”

Section: Pelvic Exenteration For Central Pelvic Recurrencementioning

confidence: 99%

Pelvic exenteration for recurrent gynaecological cancer after radiotherapy

Kolomainen

Barton

2017

The Obstetric & Gynaecologis

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Key content Exenterative procedures for recurrent gynaecological cancers are uncommon and present clinical challenges. A multidisciplinary approach is key to optimising patient outcome. Surgery is undertaken in almost all cases with curative intent, and rarely with palliative intent. Only complete histological clearance of disease (R0 resection) is associated with long‐term survival, but not in all cases. There is an absence of level 1 evidence and national guidelines. Learning objectives Understand the factors that are important in case selection. Appreciate that case selection is individualised and surgery is associated with a high morbidity and mortality rates. Understand the two components of exenterative surgery: (1) complete resection of the cancer (R0) and (2) reconstruction/restoration of pelvic functions. Most exenterations are performed for recurrent disease involving the central pelvis. Recently, radical surgery has been undertaken with favourable outcomes for pelvic sidewall disease. Ethical issues There is a paucity of data on quality‐of‐life assessment in patients undergoing exenterative surgery for recurrent gynaecological cancers. Prolonged survival may not translate into improved or acceptable quality of life. Following success from the centralisation of cancer services, consideration needs to be given to commissioning exenterative procedures in fewer centres in the UK.

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Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series

Cited by 22 publications

References 32 publications

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Urinary diversion after pelvic exenteration for gynecologic malignancies

Pelvic exenteration for recurrent gynaecological cancer after radiotherapy

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