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Lange M, Hage JJ, Hartveld L, Zijlmans HJMAA, van Beurden M. Reconstruction of the Meatus Urethrae After Oncologic Vulvectomy: Outcome of 42 Vaginal Flap Advancements in 41 Women. Ann Plast Surg 2022; 88:538-543. [PMID: 34813520 DOI: 10.1097/sap.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Resection of the distal part of the urethra is performed in 15% to 55% of women with vulvar cancer to achieve radicality of vulvectomy. Urinary reconstruction in these women may be complicated by urethral stenosis resulting from circular inset of the meatus. We report on our experience with 2 surgical techniques of noncircular inset to prevent such stenosis. METHODS From January 2005 to January 2020, 42 urethral meatus reconstructions were performed in 41 women after vulvectomy for (pre)malignant skin disorders by a "limited" (n = 17) or "extended" (n = 25) anterior vaginal wall advancement technique, including V-Y insertion of part of the vaginal flap in a posterior longitudinal urethrotomy. Preoperative characteristics, procedural details, and surgical outcomes were reviewed. RESULTS We observed 1 neomeatal stenosis and 1 case of partial vaginal wall flap necrosis as major complications following the "limited" technique and 1 circumferential neomeatal dehiscence and occlusion as major complication after the "extended" technique. Both the neomeatal stenosis and the dehiscence/occlusion are felt to have been preventable and not caused by a flaw of design of the advancement technique. CONCLUSIONS We advocate applying these vaginal wall advancement techniques to prevent circular inset of the neomeatus. The "extended" technique offers a solution in cases where the periurethral vulvar defect cannot be closed by transpositioning of labial skin.
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Affiliation(s)
- Maurits Lange
- From the Department of Plastic and Reconstructive Surgery
| | - J Joris Hage
- From the Department of Plastic and Reconstructive Surgery
| | | | - Henry J M A A Zijlmans
- Department of Gynecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marc van Beurden
- Department of Gynecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Shin J, Kim SA, Rhie JW. Perineal perforator switch flap for three-dimensional vulvovaginal reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:3208-3216. [PMID: 35717498 DOI: 10.1016/j.bjps.2022.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/12/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Vulvovaginal reconstruction is challenging. In this study, we evaluated the outcomes of vulvovaginal reconstruction with "perineal perforator switch flap" (PPSF) and compared it with other conventional flaps. In addition, the long-term esthetic results were compared with the perineal perforator propeller flap (PPPF), which we previously used. METHODS We retrospectively reviewed the clinical data of 16 patients (27 flaps) who underwent vulvovaginal reconstruction with PPSF. After tumor resection, perineal perforators close to the genitofemoral sulcus were identified. The flap was designed as an island with the perforator at the center. The flap was elevated while preserving the soft tissue surrounding the pedicle, and transferred to the defect via the subcutaneous tunnel without pedicle skeletonization. RESULTS All flaps survived and no major surgical complications were observed. The total follow-up period was 16.13±3.38 months. The mean operation time was 79.38±19.65 min, and the initiation of walking and the length of hospitalization were 1.69 ± 0.79 and 5.69 ± 0.79 days, respectively. Perineal function was well preserved. Comparison of esthetic results with PPPF showed that PPSF showed better results in symmetrical and labial shape (2.29 ± 0.73 vs. 3.13 ± 0.81; p=0.015, 2.43 ± 1.02 vs. 3.25 ± 0.68; p=0.031, respectively), and in total score. (10.29 ± 2.16 vs. 12.31 ± 1.82; p=0.017). CONCLUSION PPSF was technically simple and significantly reduced the duration of operation and the overall recovery time. PPSF also prevented delay in radiation. Therefore, PPSF is a promising method for vulvovaginal reconstruction.
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Affiliation(s)
- Jongweon Shin
- Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Tongil-ro 1021, Eunpyeong-gu, Seoul, Republic of Korea.
| | - Seong Ae Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Won Rhie
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Tock S, Wallet J, Belhadia M, Hudry D, Ghesquière L, Narducci F, Leblanc E. Outcomes of the use of different vulvar flaps for reconstruction during surgery for vulvar cancer. Eur J Surg Oncol 2019; 45:1625-1631. [DOI: 10.1016/j.ejso.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
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Franchi M, Uccella S, Zorzato PC, Dalle Carbonare A, Garzon S, Laganà AS, Casarin J, Ghezzi F. Vaginal flap for urethral neomeatus reconstruction after radical surgery for vulvar cancer: a retrospective cohort analysis. Int J Gynecol Cancer 2019; 29:1098-1104. [PMID: 31320484 DOI: 10.1136/ijgc-2019-000420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Partial urethrectomy during radical surgery for vulvar cancer may help avoid adjuvant radiotherapy in some patients. This study aimed to evaluate surgical, oncologic, and urinary outcomes of a new surgical technique based on vaginal flap to perform neomeatus reconstruction after distal urethral resection in radical surgery for vulvar cancer. METHODS Retrospective cohort study between January 2005 and December 2017. We recorded data on pre- and post-operative urinary symptoms, surgical procedures, complications, adjuvant therapy, and follow-up of all patients who underwent surgery for vulvar cancer and had distal urethral resection and neomeatus reconstruction with the proposed technique. The reconstruction was based on the development of a vaginal flap in which a circular opening was created to become the neo-outlet of the urethra. RESULTS Of a total of 200 patients with vulvar cancer operated with curative intent, 33 (16.5%) underwent distal urethral resection and neomeatus reconstruction during surgery (median age 73 (range 57-89) years; median body mass index 25.3 (range 16.3-36.4) kg/m2). Urethrectomy allowed the avoidance of adjuvant radiotherapy in 15/33 (45.5%) patients. No case of dehiscence was reported at the site of neomeatus. After a median follow-up of 39 (range 14-151) months, only one case of deviated urinary stream (3%) and no cases of neomeatus stricture were reported. Six (18.2%) patients developed or worsened urinary incontinence after urethral resection and neomeatus reconstruction, and there was no difference in the prevalence of urethral compressor muscle involvement during urethrectomy (p=0.19) and adjuvant radiotherapy (p=1.00). No recurrences were reported at urethral margins. CONCLUSIONS Distal urethral resection and neomeatus reconstruction seem to be associated with adequate healing and low complication rates, such as dehiscence, stenosis, and flux deviation/dribbling. New-onset or worsened urinary incontinence does not seem to be associated with urethral compressor muscle involvement during urethral resection or adjuvant radiotherapy.
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Affiliation(s)
- Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy
| | - Andrea Dalle Carbonare
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
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Di Donato V, Bracchi C, Cigna E, Domenici L, Musella A, Giannini A, Lecce F, Marchetti C, Benedetti Panici P. Vulvo-vaginal reconstruction after radical excision for treatment of vulvar cancer: Evaluation of feasibility and morbidity of different surgical techniques. Surg Oncol 2017; 26:511-521. [DOI: 10.1016/j.suronc.2017.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Comparison of V-Y Advancement Flap Versus Lotus Petal Flap for Plastic Reconstruction After Surgery in Case of Vulvar Malignancies. Ann Plast Surg 2017; 79:186-191. [DOI: 10.1097/sap.0000000000001094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra. Eur J Surg Oncol 2015; 41:1664-70. [DOI: 10.1016/j.ejso.2015.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/01/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022] Open
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Modified gluteal fold advancement V-Y flap for vulvar reconstruction after surgery for vulvar malignancies. Gynecol Oncol 2014; 132:125-9. [DOI: 10.1016/j.ygyno.2013.10.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/18/2013] [Accepted: 10/31/2013] [Indexed: 11/23/2022]
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Bodin F, Weitbruch D, Seigle-Murandi F, Volkmar P, Bruant-Rodier C, Rodier J. Vulvar reconstruction by a “supra-fascial” lotus petal flap after surgery for malignancies. Gynecol Oncol 2012; 125:610-3. [DOI: 10.1016/j.ygyno.2012.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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Al-Benna S, Tzakas E. Postablative reconstruction of vulvar defects with local fasciocutaneous flaps and superficial fascial system repair. Arch Gynecol Obstet 2012; 286:443-8. [PMID: 22407157 DOI: 10.1007/s00404-012-2262-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 02/16/2012] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postablative reconstruction of vulvar defects is a difficult challenge because of the functional, locational and cosmetic importance of this region. Local flaps carry a high incidence of delayed wound healing as local flaps may redistribute but not eliminate local wound tension. Repair of the superficial fascial system may avert local complications by minimising tension to the skin and increasing the initial biomechanical strength of wound. The aim of this study was to determine the clinical outcome of local fasciocutaneous flaps used for postablative reconstruction of vulvar defects in which the superficial fascial system was repaired. METHODS A retrospective analysis was conducted of patients with vulvar carcinoma in situ or vulvar carcinoma, who underwent ablation and immediate reconstruction with local fasciocutaneous flaps and superficial fascial system repair. Postoperative complications were recorded and clinical outcomes were evaluated. RESULTS Twelve of the 13 flaps healed primarily. Complications included 2 superficial wound infections, both of which were treated successfully with antibiotic therapy. One flap was complicated by minor wound dehiscence, which healed with conservative treatment. DISCUSSION 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.
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Affiliation(s)
- Sammy Al-Benna
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, North Rhine-Westphalia, Germany.
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Perforating arteries of the anteromedial aspect of the thigh: an anatomical study regarding anteromedial thigh flap. Surg Radiol Anat 2010; 33:241-7. [DOI: 10.1007/s00276-010-0738-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Nakamura Y, Ishitsuka Y, Nakamura Y, Xu X, Hori-Yamada E, Ito M, Onizawa S, Kawachi Y, Otsuka F. Modified gluteal-fold flap for the reconstruction of vulvovaginal defects. Int J Dermatol 2010; 49:1182-7. [DOI: 10.1111/j.1365-4632.2010.04578.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yamauchi T, Kiyokawa K, Inoue Y, Rikimaru H. V-Y fasciocutaneous flap of the medial thigh including the long saphenous vein for reconstruction of intrapelvic dead space. ACTA ACUST UNITED AC 2009; 43:142-7. [PMID: 19401944 DOI: 10.1080/02844310902771657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Some patients develop an intrapelvic infection and fistula caused by the presence of intrapelvic dead space after the resection of rectal cancer, and the treatment is sometimes quite difficult. We have developed a new surgical technique for the treatment and prevention of such fistulas that uses a fasciocutaneous flap from the medial thigh. A V-shaped fasciocutaneous flap with a pedicle on the anterior side of the thigh is designed on the medial thigh and gluteal region. After raising the fasciocutaneous flap that contains the long saphenous vein, the gluteal section including a thick layer of fatty tissue is de-epithelialised, and the flap is rotated and advanced towards the dead space to fill it. Four patients were operated on using our technique. One was a secondary reconstruction: the patient had developed a small fistula after reconstructive surgery, but it healed with conservative treatment. As a result, all four patients achieved satisfactory outcomes. The advantages of our technique include: no change in the position of the body is required for reconstruction; operations are simple; sufficient volume of tissue is obtained from the thick fatty tissues of the gluteal region; and the fasciocutaneous flap contains the long saphenous vein and has good venous circulation. We consider this technique useful for the reconstruction of intrapelvic dead space.
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Affiliation(s)
- Toshihiko Yamauchi
- Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
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Stepladder V–Y advancement medial thigh flap for the reconstruction of vulvoperineal region. J Plast Reconstr Aesthet Surg 2009; 62:e196-9. [DOI: 10.1016/j.bjps.2009.01.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/16/2009] [Accepted: 01/31/2009] [Indexed: 11/22/2022]
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Benito P, De Juan A, Cano M, Elena E. Reconstruction of an extensive perineal defect using two modified V-Y flaps based on perforators from the gluteus maximus muscle. J Plast Reconstr Aesthet Surg 2008; 61:e1-4. [PMID: 17669704 DOI: 10.1016/j.bjps.2007.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 06/11/2007] [Indexed: 11/20/2022]
Abstract
SUMMARY We report the case of a women with severe perineal defect secondary to a perianal cancer that required reconstruction from the posterior wall of the urinary bladder to the coccyx, and which laterally surpassed both ischial tuberosities. For this reconstructive work, we used two V-Y advanced flaps taken from the gluteal region. On the basis of these flaps, we modified the final position in the advance of the lateral ends, crossing the tips of each flap over each other to provide a greater volume of tissue in the central area, with no signs of vascular injury. We believe that the use of V-Y flaps, based on the perforating arteries of the gluteus maximus, allows the reconstruction of especially extensive defects in the perineal region. The technique is rapid and easy perform, and produces acceptable clinical outcome and minimum morbidity.
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Affiliation(s)
- P Benito
- Department of Surgery, Service of Plastic and Reconstructive Surgery, University Hospital of Salamanca, Spain.
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Weikel W, Schmidt M, Steiner E, Knapstein PG, Koelbl H. Reconstructive plastic surgery in the treatment of vulvar carcinomas. Eur J Obstet Gynecol Reprod Biol 2006; 136:102-9. [PMID: 17118519 DOI: 10.1016/j.ejogrb.2006.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 08/09/2006] [Accepted: 08/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The results obtained using plastic surgery reconstruction in 207 patients with a primary or recurrent vulvar carcinoma were analyzed with regard to the surgical procedures applied, pre-treatment and post-operative findings, along with the long-term oncological disease course. STUDY DESIGN Standardized data concerning the surgical procedures applied and clinical factors were collected in a databank and statistically analyzed. RESULTS The flaps employed were termed either 'local' (cutaneous or fasciocutaneous; n=84) or 'regional' (myocutaneous, n=123). For local flaps, the rate of secondary healing was 31%, dropping to 20% for regional flaps. Such healing disturbances often affected the donor region and did not lead to lasting clinical problems such as stenosis or distortion. Severe disturbances of wound healing (loss of more than 10%) were not observed in local flaps, whereas such problems were encountered in 5.9% of regional flaps. Gluteal thigh flaps were most frequently applied and were also the most successful type of myocutaneous reconstruction. Therapy was selected on an individual basis according to tumor status. CONCLUSION Plastic surgery reconstruction broadens the range of operative therapies available for the treatment of vulvar carcinomas, especially those at an advanced stage or recurrent tumors, and leads to a favorable oncological disease course as well as improved cosmetic results.
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Affiliation(s)
- Wolfgang Weikel
- Department of Obstetrics and Gynecology, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany
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Lee PK, Choi MS, Ahn ST, Oh DY, Rhie JW, Han KT. Gluteal Fold V-Y Advancement Flap for Vulvar and Vaginal Reconstruction: A New Flap. Plast Reconstr Surg 2006; 118:401-6. [PMID: 16874210 DOI: 10.1097/01.prs.0000227683.47836.28] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Soft-tissue reconstruction following vulvar cancer resection is a difficult challenge because of the functional, locational, and cosmetic importance of this region. Although numerous flaps have been designed for vulvar reconstruction, each has its disadvantages. METHODS The authors introduce the gluteal fold fasciocutaneous V-Y advancement flap for vulvovaginoperineal reconstruction after vulva cancer resection. This flap is supplied by underlying fascial plexus derived from perforators of the internal pudendal artery and musculocutaneous perforators of underlying muscle. The sensory supply of this flap comes from the posterior cutaneous nerve of the thigh and the pudendal nerve. An axis of V-shaped triangular flap is aligned to the gluteal fold. A total of 17 flaps were performed in nine patients. RESULTS All flaps survived completely, with no complications except for small perineal wound disruption in three patients. CONCLUSIONS This flap is thin, reliable, sensate, easy to perform, and has matched local skin quality and concealed donor-site scar on the gluteal fold. In addition, it can cover large vulvovaginal defects because it can be advanced farther as a result of the character of the gluteal fold area. In our experience, the gluteal fold fasciocutaneous V-Y advancement flap has proven very useful for vulvar reconstruction, especially at the point of donor-site scar, flap thickness, and degree of flap advancement.
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Affiliation(s)
- Paik-Kwon Lee
- Department of Plastic Surgery, The Catholic University of Korea College of Medicine, Seocho-gu, Seoul 137-040, South Korea.
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Persichetti P, Cogliandro A, Marangi GF, Simone P, Cagli B. Triple intercalated flaps in perineal urethral replacement: an efficient technique to prevent circumferential urethral stenosis. Plast Reconstr Surg 2006; 117:708-10. [PMID: 16462391 DOI: 10.1097/01.prs.0000197919.40537.1d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salgarello M, Farallo E, Barone-Adesi L, Cervelli D, Scambia G, Salerno G, Margariti PA. Flap algorithm in vulvar reconstruction after radical, extensive vulvectomy. Ann Plast Surg 2005; 54:184-90. [PMID: 15655471 DOI: 10.1097/01.sap.0000141381.77762.07] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to assess the reconstructive options after radical, extensive vulvectomy; relate them to tumor characteristics; and select a choice of flaps able to correct every remaining defect. This study is a retrospective review of a 4-year experience with 31 flaps in 20 consecutive vulvar reconstructions. Three of the 31 flaps presented nonsignificant delayed healing at their tips and 3 other flaps developed a major breakdown related to an infection or an error in flap planning. According to the authors, the size of the defect is the main issue that must be taken into consideration during the establishment of reconstructive needs. Closure of vulvar defects is preferably performed using fasciocutaneous flaps, which are very reliable flaps and can be raised with different techniques to meet different needs. A flap is then chosen with the fewest potential complications. An algorithm has been thus established: Small to medium-size defects are closed with island V-Y flaps, island gluteal fold flaps, or pedicled pudendal thigh flaps. Among them, the island V-Y flap is the workhorse flap for vulvar reconstruction because of its versatility, reliability, and technical simplicity compared with its very low complication rate. If the vulvar defect is large and/or reaches the vulva-crural fold, V-Y flaps are also preferred to close these large and posteriorly extended excisions. If the vulvar defect is very large, extending both anteriorly and posteriorly, the use of a distally based, vertically oriented rectus abdominis muscle flap is recommended. Using this algorithm, immediate vulvar reconstruction with pedicled local or regional flaps can be performed easily and reliably.
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Affiliation(s)
- Marzia Salgarello
- Department of Plastic Surgery, Catholic University of the Sacred Heart, Rome, Italy.
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Hallock GG. The Medial Circumflex FemoralGRACILIS Local Perforator Flap–A Local Medial Groin Perforator Flap. Ann Plast Surg 2003; 51:460-4. [PMID: 14595180 DOI: 10.1097/01.sap.0000096149.92205.44] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The medial circumflex femoral(GRACILIS) perforator free flap has been previously used to capture the superior medial thigh skin territory. This can also be valuable as a local flap, especially for adjacent groin wounds that are not uncommon after vascular interventions. Uncomplicated healing without vascular compromise was achieved using this as a local flap in 4 recent cases. Because the gracilis muscular branches can be independently dissected from the musculocutaneous perforators, the muscle itself can be separately included to form a combined conjoint flap, where the muscle is specifically only used to wrap around and protect any exposed vascular structures while the cutaneous component simplifies skin wound closure. The axis of rotation of the medial circumflex femoral perforator local flap extends throughout the groin region and potentially to the lateral thigh. This is an ideal local perforator flap because the source pedicle has a consistent location already well known to most plastic surgeons, the boundaries of the potential skin territory are reliable and well defined, and the scar from closure of the donor site within the medial groin can be readily concealed by clothing.
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Affiliation(s)
- Geoffrey G Hallock
- Division of Plastic Surgery, The Lehigh Valley Hospitals, Allentown, Pennsylvania, USA.
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