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Dzyubak O, Salman L, Covens A. Use of Rectus Flaps in Reconstructive Surgery for Gynecologic Cancer. Curr Oncol 2024; 31:394-402. [PMID: 38248111 PMCID: PMC10814897 DOI: 10.3390/curroncol31010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The aim of this study was to explore the outcomes of pelvic reconstruction with a rectus abdominis myocutaneous (RAM) or rectus abdominis myoperitoneal (RAMP) flap following radical surgery for gynecologic malignancy. This is a retrospective case series of all pelvic reconstructions with RAM or RAMP flap performed in a gynecologic oncology service between 1998 and 2023. Reconstructions with other flaps were excluded. A total of 28 patients were included. Most patients had vulvar cancer (n = 15, 53.6%) and the majority had disease recurrence (n = 20, 71.4%). Exenteration was the most common procedure, being carried out in 20 (71.4%) patients. Pelvic reconstruction was carried out with a RAM flap in 24 (85.7%) cases and a RAMP flap in 4 (14.3%) cases. Flap-specific complications included cellulitis (14.3%), partial breakdown (17.9%), and necrosis (17.9%). Donor site complications included surgical site infection and necrosis occurring in seven (25.0%) and three (10.7%) patients, respectively. Neovaginal reconstruction was performed in 14 patients. Out of those, two (14.3%) had neovaginal stenosis and three (21.4%) had rectovaginal fistula. In total, 50% of patients were disease-free at the time of the last follow up. In conclusion, pelvic reconstruction with RAM/RAMP flaps, at the time of radical surgery for gynecologic cancer, is an uncommon procedure. In our case series, we had a significant complication rate with the most common being infection and necrosis. The development of a team approach, with input from services including Gynecologic Oncology and Plastic Surgery should be developed to decrease post-operative complications and improve patient outcomes.
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Affiliation(s)
- Oleksandra Dzyubak
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Lina Salman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada; (O.D.); (L.S.)
- Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada
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Classen-von Spee S, Baransi S, Fix N, Rawert F, Luengas-Würzinger V, Lippert R, Bonin-Hennig M, Mallmann P, Lampe B. Pelvic Exenteration for Recurrent Vulvar Cancer: A Retrospective Study. Cancers (Basel) 2024; 16:276. [PMID: 38254766 PMCID: PMC10813412 DOI: 10.3390/cancers16020276] [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: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Pelvic exenteration (PE) is one of the most radical surgical approaches. In earlier times, PE was associated with high morbidity and mortality. Nowadays, due to improved selection of suitable patients, perioperative settings, and postoperative care, patients' outcomes have been optimized. To investigate patients' outcomes and identify possible influencing clinical and histopathological factors, we analysed 17 patients with recurrent vulvar cancer who underwent PE in our department between 2007 and 2022. The median age was 64.9 years, with a difference of 40 years between the youngest and the oldest patient (41 vs. 81 years). The mean overall survival time was 55.7 months; the longest survival time reached up to 164 months. The achievement of complete cytoreduction (p = 0.02), the indication for surgery (curative vs. palliative), and the presence of distant metastases (both p = 0.01) showed a significant impact on overall survival. The presence of lymphatic metastases (p = 0.11) seems to have an influence on overall survival (OS) time. Major complications appeared in 35% of the patients. Our results support the existing data for PE in cases of recurrent vulvar cancer; for a group of selected patients, PE is a treatment option with good overall survival times and acceptable morbidity.
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Affiliation(s)
- Sabrina Classen-von Spee
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Saher Baransi
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Nando Fix
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Friederike Rawert
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Verónica Luengas-Würzinger
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Ruth Lippert
- Department of Pathology, Evangelisches Krankenhaus Oberhausen, Virchowstraße 20, 46047 Oberhausen, Germany
| | - Michelle Bonin-Hennig
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Björn Lampe
- Department of Gynecology and Obstetrics, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany; (S.B.); (N.F.); (F.R.); (V.L.-W.); (M.B.-H.)
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3
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Oonk MHM, Planchamp F, Baldwin P, Mahner S, Mirza MR, Fischerová D, Creutzberg CL, Guillot E, Garganese G, Lax S, Redondo A, Sturdza A, Taylor A, Ulrikh E, Vandecaveye V, van der Zee A, Wölber L, Zach D, Zannoni GF, Zapardiel I. European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023. Int J Gynecol Cancer 2023; 33:1023-1043. [PMID: 37369376 PMCID: PMC10359596 DOI: 10.1136/ijgc-2023-004486] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. OBJECTIVE To update the ESGO guidelines based on the new evidence addressing the management of vulvar cancer and to cover new topics in order to provide comprehensive guidelines on all relevant issues of diagnosis and treatment of vulvar cancer. METHODS The ESGO Council nominated an international development group comprised of practicing clinicians who provide care to vulvar cancer patients and have demonstrated leadership through their expertize in clinical care and research, national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (18 experts across Europe). To ensure that the statements were evidence-based, new data identified from a systematic search were reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 206 international practitioners in cancer care delivery and patient representatives. RESULTS The updated guidelines cover comprehensively diagnosis and referral, staging, pathology, pre-operative investigations, surgical management (local treatment, groin treatment, sentinel lymph node procedure, reconstructive surgery), (chemo)radiotherapy, systemic treatment, treatment of recurrent disease (vulvar, inguinal, pelvic, and distant recurrences), and follow-up. Management algorithms are also defined.
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Affiliation(s)
- Maaike H M Oonk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Sven Mahner
- University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Daniela Fischerová
- Charles University First Faculty of Medicine, Prague, Czech Republic
- General University Hospital in Prague, Prague, Czech Republic
| | | | | | - Giorgia Garganese
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sigurd Lax
- Hospital Graz II, Graz, Austria
- Johannes Kepler Universitat Linz, Linz, Austria
| | | | | | | | - Elena Ulrikh
- Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | | | - Ate van der Zee
- University Medical Center Groningen, Groningen, The Netherlands
| | - Linn Wölber
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Diana Zach
- Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet Eugeniavägen, Stockholm, Sweden
| | - Gian Franco Zannoni
- Catholic University of the Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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4
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Guinier C, de Clermont-Tonnerre E, Tay JQ, Ng ZY, Cetrulo CL, Lellouch AG. The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:130. [PMID: 36819501 PMCID: PMC9929810 DOI: 10.21037/atm-22-2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Abstract
Background and Objective The deep inferior epigastric artery perforator (DIEP) flap was first described by Koshima and Soeda in 1989 and is now well-established as the gold standard in breast reconstruction. Lately, this issue has been explored in the context of head and neck reconstruction, highlighting growing interest in the use of the DIEP flap beyond breast reconstruction, but its usage in other anatomical regions appears elusive. Nevertheless, DIEP flap reconstruction may be a viable choice for complex, three-dimensional head and neck deformities while upholding the criteria of minimal donor site morbidity, according to a recent review. To determine whether the DIEP flap may be used successfully in other types of reconstruction, we conducted a review on the use, applications, and outcomes of the DIEP flap in non-breast reconstruction. This is, as far as we are aware, the first comprehensive analysis of all applications of the DIEP flap other than for breast reconstruction. Methods A literature review was performed using PubMed to include all relevant articles in English or French published up to February 2022. Keywords included "DIEP flap" and "deep inferior epigastric perforator flap". Key Contents and Findings A total of 1,299 articles were identified with 105 on the use of the DIEP flap in non-breast reconstruction. This suggests increasing recognition of the DIEP flap as a feasible option for reconstruction of most anatomical regions, especially in lower limb and head and neck reconstruction, followed by gynecological reconstruction. The DIEP flap was also utilized in the reconstruction of upper limb, thigh and hip defects. Less commonly, it has been used for penoscrotal, groin, sternal, buttock and abdomen reconstruction. Conclusions The scientific body of evidence showed the robustness and versatility of the DIEP flap in non-breast reconstruction, with its relative pros and cons at different anatomical regions.
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Affiliation(s)
- Claire Guinier
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Plastic and Reconstructive Surgery Department, Tenon Hospital, Paris, France
| | - Eloi de Clermont-Tonnerre
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Plastic and Reconstructive Surgery Department, Tenon Hospital, Paris, France
| | | | - Zhi Yang Ng
- Plastic Surgery, School of Surgery, Oxford, UK
| | - Curtis L. Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Plastic and Reconstructive Surgery Department, Massachusetts General Hospital, Boston, MA, USA;,Plastic Surgery, Shriners Hospital for Children, Boston, MA, USA
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Boston, MA, USA;,Plastic Surgery, School of Surgery, Oxford, UK;,Plastic and Reconstructive Surgery Department, Massachusetts General Hospital, Boston, MA, USA;,Plastic Surgery, Shriners Hospital for Children, Boston, MA, USA
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5
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Korotkov VA, Petrov LO, Kasymov MR, Pasov VV, Skoropad VY, Tivkova LV, Yamshchikova AS, Grigoriev NS, Abramova OE, Naumov NP, Kaprin AD, Ivanov SA. Surgical treatment of vulvar cancer with perineal defect reconstruction using a VRAM flap. Clinical case. ANDROLOGY AND GENITAL SURGERY 2023. [DOI: 10.17650/2070-9781-2022-23-4-103-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The article presents a clinical case of perineal defect reconstruction using a VRAM flap in a patient with vulvar cancer. Stepwise surgical treatment method is described. A multidisciplinary meeting allows to realize a plan of surgical help for such patients with the goal of treating oncological process and its complications.We have proposed a variant of perineal defect reconstruction through transfer of a vertical rectus abdominis musculocutaneous flap with a vascular pedicle.
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Affiliation(s)
- V. A. Korotkov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - L. O. Petrov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - M. R. Kasymov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - V. V. Pasov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - V. Yu. Skoropad
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - L. V. Tivkova
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - A. S. Yamshchikova
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - N. S. Grigoriev
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - O. E. Abramova
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - N. P. Naumov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - A. D. Kaprin
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
| | - S. A. Ivanov
- A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre, Ministry of Health of Russia
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Li YX, Chang WC, Huang KJ, Wu CJ, Wei LH, Sheu BC. Effectual surgical perineal reconstruction of malignant mucosal vulvar melanoma. Taiwan J Obstet Gynecol 2023; 62:167-170. [PMID: 36720534 DOI: 10.1016/j.tjog.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To demonstrate a successful surgical treatment and reconstruction in a case of malignant mucosal vulvar melanoma. CASE REPORT A 52-year-old woman had stage II bulky malignant mucosal vulvar melanoma and received wide surgical excision with partial vulvectomy. She underwent 2-steps reconstructive vulvoplasty and vaginoplasty with skin grafting 1 year after initial surgical treatment. There was no evidence of recurrence after 3 years of follow-up. CONCLUSION Vulvar melanoma is a rare malignant neoplasm. Wide local excision with reconstruction can relieve pelvic discomfort and restore local function after the surgery.
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Affiliation(s)
- Ying-Xuan Li
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Ju Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Jui Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Lin-Hung Wei
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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7
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Rectus Abdominis Myocutaneous Flap and its Modifications in Perineal and Vulva Reconstruction: a Case Series Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Importance Vulvar reconstruction may be required after vulvectomy or any vulvar surgery. Providers should be familiar with techniques for reconstruction to improve clinical outcomes. Objective This article reviews the different techniques for reconstruction after vulvectomy and describes the decision-making process for selection of appropriate techniques, postoperative care, and expected outcomes. Evidence Acquisition A literature search was conducted, focusing on the plastic surgery and gynecologic oncology literature, using the following search terms: "vulvar reconstruction," "perineal reconstruction," "vulvectomy," and "vulvar cancer." The search was limited to English publications. Results Reconstruction after vulvectomy can be performed using a variety of techniques ranging from simple or complex closure to adjacent tissue rearrangement to skin grafting, locoregional, and free flaps. The appropriate technique is best chosen based on the characteristics of the patient and postablative defect, as well as the reconstructive goals. Postoperative complications are usually minor. Conclusions Vulvar reconstruction techniques vary widely and offer patients improved outcomes. Relevance Knowledge of vulvar reconstruction techniques is necessary for gynecologists performing vulvar surgery to ensure optimal patient outcomes.
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Trott S, Höckel M, Dornhöfer N, Geue K, Aktas B, Wolf B. Quality of life and associated factors after surgical treatment of vulvar cancer by vulvar field resection (VFR). Arch Gynecol Obstet 2020; 302:191-201. [PMID: 32430759 PMCID: PMC7266857 DOI: 10.1007/s00404-020-05584-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
Purpose To investigate patient-reported quality of life (QoL) and associated factors in vulvar cancer patients treated surgically by vulvar field resection (VFR) without adjuvant radiation. Methods We retrospectively evaluated patient-reported QoL as part of the prospective monocentric VFR trial using the 30-item European Organization for Research and Treatment of Cancer quality-of-life questionnaire (EORTC QLQ-C30) supplemented by a question assessing sexual activity. All patients had been treated by VFR and no participant had received adjuvant radiotherapy. The gynecologic cancer lymphedema questionnaire (GCLQ) was used to determine the presence of lymphedema. Structured telephone interviews were conducted to assess postoperative sequelae and long-term complications. Results Forty-three VFR patients (median age 63 years) were available for QoL assessment. Thirty-eight (88%) had received inguinal lymph-node dissection in addition to VFR. Mean global QoL (global health status) rating among all patients was 66.1 (± 25.5) on a scale from 0 to 100 with higher scores indicating better QoL. Higher GCLQ scores were significantly associated with lower global QoL scores (Spearman's rank correlation ρ =− 0.7, p < 0.0001). The presence of preoperative co-morbidities and postoperative wound-healing complications were also linked to reduced QoL (p < 0.01 for both). In a multivariable regression model, there was a significant interaction between preoperative co-morbidities and wound-healing complications with regard to global QoL (p < 0.05). Conclusion Overall, VFR patients exhibit good quality of life postoperatively. The presence of lymphedema, wound-healing complications, and preoperative morbidities were associated with reduced QoL. Prospective longitudinal studies have to confirm our findings in the future. Electronic supplementary material The online version of this article (10.1007/s00404-020-05584-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophia Trott
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Michael Höckel
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Nadja Dornhöfer
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Kristina Geue
- Division of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Bahriye Aktas
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology, University Hospital Leipzig, Liebigstr. 20a, 04103, Leipzig, Germany.
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Brousse S, Joste M, Leclère FM, Lavoué V, Bertheuil N. Unilateral superficial external pudendal artery (SEPA) propeller perforator flap (PPF) for vulvar reconstruction after cancer treatment. Eur J Obstet Gynecol Reprod Biol 2019; 241:135-137. [PMID: 31500926 DOI: 10.1016/j.ejogrb.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/11/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Susie Brousse
- Department of Obstetrics and Gynecology, Hôpital Sud, Rennes, France; Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France.
| | - Marine Joste
- Department of Obstetrics and Gynecology, Hôpital Sud, Rennes, France; Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France
| | - Franck Marie Leclère
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hôpital Sud, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hôpital Sud, Rennes, France
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11
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Quality of Life and Sexual Functioning After Vulvar Reconstruction With the Lotus Petal Flap. Int J Gynecol Cancer 2019; 28:1728-1736. [PMID: 30157166 DOI: 10.1097/igc.0000000000001340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Resection of (pre) malignant lesions in the vulvoperineal area may result in large defects that cannot be closed primarily. The lotus petal flap technique is widely used for reconstruction. The aim of this study was to evaluate both quality of life (QoL) and sexual functioning of patients who underwent the lotus petal flap procedure, because no data are available on this topic. METHODS A cross-sectional study was performed on all eligible patients (N = 38) who underwent the lotus petal flap procedure between 2005 and 2016. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, Female Sexual Function Index, and Body Image Scale were used to evaluate QoL and sexual functioning. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Female Sexual Function Index scores were compared with scores of age-matched healthy women. RESULTS Twenty-six patients (68%) responded. The mean (SD) age was 65.5 (16.3) years, and the median follow-up time was 38.5 months (range 16-141 months). Quality of life scores were lower compared with healthy women in the domains physical, role, and social functioning. Sexual activity rates were comparable with healthy women; however, sexual functioning was worse. Although patients were satisfied about their sexual life, pain was reported. CONCLUSIONS Patients who underwent vulvar reconstructive surgery with lotus petal flaps seem to have a lower QoL compared with healthy women. Patients report more pain during sexual activity but are satisfied about their sexual functioning. These results should be included in preoperative counseling and follow-up of future patients eligible for vulvar reconstruction with a lotus petal flap.
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Deng D, Liu J, Chen F, Lv D, Gan W, Li L, Wang J. Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma. Medicine (Baltimore) 2018; 97:e12839. [PMID: 30313121 PMCID: PMC6203530 DOI: 10.1097/md.0000000000012839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Salvage surgery is usually the only treatment for recurrent head and neck tumors but often poses a challenge to surgeons due to post-resected defects at 2 or more sites. Here we present the outcomes and rationale for reconstruction by a double-island anterolateral thigh (ALT) free flap following the salvage surgery.Patients treated with double-island ALT free flaps in salvage surgery between September 2012 and January 2017 at West China Hospital, Sichuan University were retrospectively viewed.A total of 18 patients (15 males) underwent reconstruction with double-island ALT free flaps (range from 40 to 77 years old). All patients had recurrent tumors after surgery and/or chemoradiotherapy and were selected for salvage surgery by a multidisciplinary team. The flaps were initially harvested as 7 cm × 7 cm to 16 cm × 10 cm single blocks and then divided into double-island flaps with each individual paddle ranging from5 cm × 3 cm to 10 cm × 8 cm. The average flap thickness was 3.5 cm (range from 2 to 6 cm), and the average pedicle length was 8 cm (range from 6 to 10 cm). A total of 18 arteries and 32 veins were anastomosed. Three patients developed fistula, 1 developed flap failure due to thrombosis and was re-operated with a pedicle flap. One patient died of pulmonary infection 6 months after the operation.Flap reconstruction for complex head and neck defects after salvage surgery remains challenging, but double-island ALT free flap reconstruction conducted by a multidisciplinary team and experienced surgeons would have a role in this setting.
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13
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Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort. Int J Gynecol Cancer 2018; 28:1606-1615. [PMID: 30095703 DOI: 10.1097/igc.0000000000001332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine complications associated with primary closure compared with reconstruction after vulvar excision and predisposing factors to these complications. METHODS Patients undergoing vulvar excision with or without reconstruction from 2011 to 2015 were abstracted from the National Surgical Quality Improvement Program database. Common Procedural Terminology codes were used to characterize surgical procedures as vulvar excision alone or vulvar excision with reconstruction. Patient characteristics and 30-day outcomes were used to compare the 2 procedures. Descriptive and univariate statistics were performed. Adjusted odds ratios and confidence intervals were calculated using a logistic regression model to control for potential confounders. Two-sided α with P < 0.05 was designated as significant. RESULTS A total of 2698 patients were identified; 78 (2.9%) underwent reconstruction. There were no differences in age, race, body mass index, diabetes, hypertension, tobacco use, heart failure, renal failure, or functional status between the 2 groups. American Society of Anesthesiologists class 3 and 4 patients and those with disseminated cancer were more likely to undergo reconstruction (both P < 0.001). On univariate analysis, reconstruction was associated with increased risk of readmission, surgical site infection, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, sepsis, septic shock, unplanned reoperation, longer hospital stay, need for skilled nursing or subacute rehab on discharge, and death within 30 days. On logistic regression analysis, disseminated cancer, American Society of Anesthesiologists classes 3 and 4 and reconstruction remained significant risk factors for readmission and any postoperative complication. CONCLUSIONS Patients undergoing vulvar excision with reconstruction are at increased risk for readmission and postoperative complications compared with those undergoing excision alone. Careful patient selection and efforts to optimize surgical readiness are needed to improve outcomes. Long-term data could help determine if these 30-day outcomes are a reliable measure of surgical quality in vulvar surgery.
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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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