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Huang W, Hu X, Cai W, Cheng M, Fang M, Sun Z, Hu T, Yan W. Soft-tissue reconstruction with pedicled vertical rectus abdominis myocutaneous flap after total or high sacrectomy for giant sacral tumor. J Plast Reconstr Aesthet Surg 2024; 91:173-180. [PMID: 38417394 DOI: 10.1016/j.bjps.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/23/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The large soft-tissue defect after total or high sacrectomy for giant sacral tumor induces high incidence of wound complications. It remains a huge challenge to reconstruct the soft-tissue defect and achieve the preferred clinical outcome. METHODS A total of 27 patients undergoing one-stage total or high sacrectomy for giant sacral tumors between 2016 and 2021 in a tertiary university hospital were retrospectively reviewed. Participants were divided into two groups. Thirteen patients underwent a pedicled vertical rectus abdominis myocutaneous (VRAM) flap reconstruction, whereas 14 patients underwent a conventional wound closure. Patient's clinical characteristics, surgical duration, postoperative complications, and outcomes were compared between the two groups. RESULTS Patients in VRAM and non-VRAM groups were similar in baseline characteristics. The mean tumor size was 12.85 cm (range: 10-17 cm) in VRAM group and 11.79 cm (range: 10-14.5 cm) in non-VRAM group (P = 0.139). The most common giant sacral tumor is chordoma. Patients in VRAM group had a shorter length of drainage (9.85 vs 17.14 days), postoperative time in bed (5.54 vs 17.14 days), and total length of stay (19.46 vs 33.36 days) compared with patients in non-VRAM group. Patients in the VRAM group had less wound infection and debridement than patients in non-VRAM group (15.4% vs 57.1%, P < 0.001). CONCLUSIONS This study demonstrates the advantages of pedicled VRAM flap reconstruction of large soft-tissue defects after high or total sacrectomy using the anterior-posterior approach. This choice of reconstruction is better than direct wound closure in terms of wound infection, length of drainage, and total length of stay.
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Affiliation(s)
- Wending Huang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiluo Cai
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Mo Cheng
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Meng Fang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhengwang Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tu Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Fisher MH, Woods JFC, Bartlett EK, Nelson JA. A rare case of rhabdomyosarcoma identified in a VRAM flap after lower extremity reconstruction. J Surg Case Rep 2023; 2023:rjad083. [PMID: 36919020 PMCID: PMC10008218 DOI: 10.1093/jscr/rjad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/05/2023] [Indexed: 03/14/2023] Open
Abstract
Spindle cell sclerosing rhabdomyosarcoma (sc-RMS) is an extremely rare soft tissue tumor. We report an unusual case of sc-RMS in a 36-year-old patient whose tumor arose in a rectus abdominis muscle free flap that had been used for lower extremity reconstruction 18 years previously. After surgical excision of the tumor and immediate reconstruction, the patient has remained in remission and has full function of his lower extremity six months after diagnosis and treatment.
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Affiliation(s)
- Marlie H Fisher
- Medical Scientist Training Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jack F C Woods
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edmund K Bartlett
- Department of Gastric and Mixed Tumors Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kim E, Fernando C, McCombie A, Bailey W, Frizelle F, Glyn T, Porter C, Wakeman C, Creagh T. Abdominal and perineal hernia rates following vertical rectus abdominis myocutaneous ( VRAM) flap reconstruction - a supraregional experience. J Plast Reconstr Aesthet Surg 2021; 75:1158-1163. [PMID: 34895852 DOI: 10.1016/j.bjps.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/01/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vertical rectus abdominis myocutaneous (VRAM) flap has proven to be a robust reconstruction method following radical pelvic surgery. Radical pelvic surgery is associated with high morbidity due to pelvic complications and non-healing perineal wounds, as a result of non-collapsible pelvic dead space and pre-operative adjuvant radiotherapy insult. VRAM flap reconstruction addresses both issues by obliterating the dead space and introducing healthy non-radiated tissue. However, flap reconstruction complications can include donor site hernias (abdominal wall), perineal hernias, and flap-specific complications. This study aimed to evaluate the abdominal and perineal hernia rates as well as radiological evidence of flap vascularity post-operatively. METHODS We conducted a retrospective analysis of patients who underwent a VRAM flap reconstruction following radical pelvic surgery at Christchurch hospital over a 10-year period. We identified the presence of donor site hernias (abdominal wall hernias), perineal hernias, and flap vascularity on post-operative radiological imaging performed within 48 months. RESULTS Seventy-seven patients underwent a VRAM flap reconstruction of which 60 patients met the inclusion requirements for the study (mean age was 60.3 years [range 26-89]; 31 were male and 29 were female). Eighteen patients underwent an APR and 42 underwent a partial or a complete pelvic exenteration and the majority of them (75.0%) were for rectal cancers. Available imaging was on average 21.6 months post-operatively (IQR 11.8-31.3 months). The donor site hernia rate was 16.7%, and the perineal hernia rate was 3.3%. VRAM flap appeared to have DIEA flow in 98.3% of the patients. CONCLUSION VRAM flap reconstruction of complex pelvic defects remains a robust method of choice in complex pelvic reconstruction with little morbidity.
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Affiliation(s)
- Eric Kim
- Department of plastic and reconstructive surgery, Christchurch hospital.
| | | | | | | | - Frank Frizelle
- Department of general surgery, Christchurch hospital; Department of general surgery, University of Otago Christchurch
| | - Tamara Glyn
- Department of general surgery, Christchurch hospital; Department of general surgery, University of Otago Christchurch
| | - Chris Porter
- Department of plastic and reconstructive surgery, Christchurch hospital
| | - Chris Wakeman
- Department of general surgery, Christchurch hospital; Department of general surgery, University of Otago Christchurch
| | - Terry Creagh
- Department of plastic and reconstructive surgery, Christchurch hospital
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Bernuth S, Jakubietz M, Isbert C, Reibetanz J, Meffert R, Jakubietz R, Schmidt K. Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer. Technol Health Care 2021; 30:815-825. [PMID: 34744033 DOI: 10.3233/thc-213021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. OBJECTIVE Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. METHODS 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. RESULTS Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. CONCLUSION The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.
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Affiliation(s)
- Silvia Bernuth
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Germany
| | - Michael Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Germany
| | - Christoph Isbert
- Department of General, Visceral and Coloproctological Surgery, Amalie Sieveking Hospital Hamburg, Germany
| | - Joachim Reibetanz
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Germany
| | - Rainer Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Germany
| | - Rafael Jakubietz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Germany
| | - Karsten Schmidt
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Germany
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Waldner M, Elgendy TY, Kim DY, Öksüz S, Schweizer R, Zhang W, Minervini MI, Komatsu C, Plock JA, Gorantla VS, Washington KM, Thomson AW, Solari MG. Heterotopic Transplantation of Allogeneic Vertical Rectus Abdominis Myocutaneous Flaps in Miniature Swine. J Surg Res 2020; 254:175-82. [PMID: 32450418 DOI: 10.1016/j.jss.2020.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vascularized composite tissue allotransplantation (VCA) opens new possibilities for reconstruction of complex tissue defects, including upper extremity and facial transplantation. The main challenges in VCA transplantation are the side effects of long-term immunosuppression and chronic graft rejection. Translational preclinical animal models are crucial for VCA research to improve clinical outcomes and to study underlying immunologic mechanisms. Herein, we describe a novel, large animal, non-bone-bearing VCA model in inbred, swine leukocyte antigen-typed miniature swine. METHODS Transplantation of vertical rectus abdominis myocutaneous (VRAM) flaps was performed between fully swine leukocyte antigen-mismatched miniature swine. The flaps were transferred to the posterolateral aspect of the neck of recipients and anastomosed to the common carotid artery and internal jugular vein. Different immunosuppressive drug regimens were used. Clinical graft evaluation was performed daily, and punch biopsies were taken for histology. RESULTS Ten VRAM transplants were performed. The mean ischemia time was 89.4 min (SD ± 47), mean pedicle length 7.5 cm (SD ± 2), mean venous diameter 2.5 mm (SD ± 0.4), and mean arterial diameter 2.2 mm (SD ± 0.3). Follow-up demonstrated good correlation between clinical appearance and progression of graft rejection confirmed by histologic assessment. Complications were intraoperative cardiac arrest in one recipient and one flap loss due to venous compromise. CONCLUSIONS VRAM transplantation in miniature swine is an appropriate preclinical VCA model, with the advantage of good clinical and histologic correlation during the course of rejection, as well as easy access to the graft. The availability of inbred, haplotyped animals allows studies across different major histocompatibility complex barriers in a non-bone-bearing VCA.
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Horch RE, Ludolph I, Cai A, Weber K, Grützmann R, Arkudas A. Interdisciplinary Surgical Approaches in Vaginal and Perineal Reconstruction of Advanced Rectal and Anal Female Cancer Patients. Front Oncol 2020; 10:719. [PMID: 32477947 PMCID: PMC7237715 DOI: 10.3389/fonc.2020.00719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022] Open
Abstract
Relapsing or far advanced rectal and anal cancers remain difficult to treat and require interdisciplinary approaches. Due to modern standard protocols all patients receive irradiation and neoadjuvant chemotherapy-and in case of a relapse a second irradiation-rendering the surgical site prone to surgical site infections and oftentimes long lasting sinus and septic complications after exenteration in the pelvis. Despite an improved overall survival rate in these patients the downside of radical tumor surgery in the pelvis is a major loss of quality of life, especially in women when parts of the vagina need to be resected. Derived from our experince with over 300 patients receiving pelvic and perineal reconstruciton with a transpelvic vertical rectus abdominis myocutaneous (tpVRAM) flap we studied the impact of this surgical technique on the outcomes of female patients with or without vaginal reconstruction following pelvic exenteration. We found out that the tpVRAM flap is reliably perfused and helps to reduce long term wound healing desasters in the irradiated perineal/vaginal/gluteal region.
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Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Aijia Cai
- Department of Plastic and Hand Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Klaus Weber
- Department of Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital Erlangen-Friedrich Alexander University of Erlangen-Nuernberg FAU, Erlangen, Germany
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Rouch JD, Li A, Cohen JG, Kazanjian KK, Festekjian JH. Re-exploration of vertical rectus abdominis myocutaneous flap for vaginal reconstruction: Case report and review of the literature. JPRAS Open 2017; 15:32-35. [PMID: 32158795 PMCID: PMC7061550 DOI: 10.1016/j.jpra.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/23/2017] [Indexed: 10/28/2022] Open
Abstract
The vertical rectus abdominis myocutaneous (VRAM) flap is a versatile and well-established reconstructive technique for many defects created as a result of colorectal and gynecologic extirpation. However, major re-operation in the pelvis following a VRAM flap reconstruction several months later is uncommon, and the safety and integrity of the VRAM flap in this setting has not been described. This case examines VRAM flap preservation during repeat exploratory laparotomy, and a unique view of the VRAM flap during interval exploration. We demonstrate an intact flap after lysis of adhesions with an audible Doppler signal, and maintenance of flap integrity in the postoperative period. This further substantiates its use as a durable rotational flap for perineal tissue defects.
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Affiliation(s)
- Joshua D Rouch
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Andrew Li
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Joshua G Cohen
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kevork K Kazanjian
- Division of Colon and Rectal Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jaco H Festekjian
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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Pantelides NM, Young SS, Iyer S. The rectus abdominis muscle advancement flap as a salvage option for chest wall reconstruction. Ann R Coll Surg Engl 2017; 99:e142-e144. [PMID: 28462651 DOI: 10.1308/rcsann.2017.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We describe a previously unreported technique of advancing the rectus abdominis muscle superiorly, based on the deep inferior epigastric artery, to cover a lower anterior chest wall defect. This technique represents an important salvage option for chest wall reconstruction and affords a great deal of intra-operative flexibility.
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Affiliation(s)
- N M Pantelides
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston , UK
| | - S S Young
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston , UK
| | - S Iyer
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston , UK
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Coombs DM, Patel NB, Zeiderman MR, Wong MS. The Vertical Rectus Abdominis Musculocutaneous Flap As a Versatile and Viable Option for Perineal Reconstruction. Eplasty 2017; 17:ic2. [PMID: 28154619 PMCID: PMC5247671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Nirav B. Patel
- bDivision of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, Ca
| | - Matthew R. Zeiderman
- bDivision of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, Ca
| | - Michael S. Wong
- bDivision of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, Ca
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Ferron G, Gangloff D, Querleu D, Frigenza M, Torrent JJ, Picaud L, Gladieff L, Delannes M, Mery E, Boulet B, Balague G, Martinez A. Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series. Gynecol Oncol 2015; 138:603-8. [PMID: 26121919 DOI: 10.1016/j.ygyno.2015.06.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/11/2023]
Abstract
Vaginal reconstruction after pelvic exenteration (PE) represents a challenge for the oncologic surgeon. Since the introduction of perforator flaps, using pedicled vertical DIEP (deep inferior epigastric perforator) flap allows to reduce the donor site complication rate. From November 2012 to December 2014, 27 PEs were performed in our institution. 13 patients who underwent PE with vaginal reconstruction and programmed DIEP procedure for gynecologic malignancies were registered. Nine patients underwent PE for recurrent disease and four for primary treatment. Six of the 13 patients have a preoperative fistula. Anterior PE was performed in 10 patients, and total PE in 3 patients. A vertical DIEP flap was performed in 10 patients using one or two medial perforators. The reasons for abortion of vertical DIEP flap procedure were: failure to localizing perforator vessels in two cases, and unavailability of plastic surgeon in one case. A vertical fascia-sparring rectus abdominis myocutaneous flap was then harvested. Median length of surgery was 335min, and 60min for DIEP harvesting and vaginal reconstruction. No flap necrosis occurred. One patient in the VRAM (vertical rectus abdominis myocutaneous) group experienced a late incisional hernia and one patient in the DIEP flap group required revision for vaginal stenosis. In our experience, DIEP flap represents our preferred choice of flap for circumferential vaginal reconstruction after PE. To achieve a high reproducibility, the technically demanding pedicled vertical DIEP flap has to be harvested by a trained surgeon, after strict evaluation of the preoperative imaging with identification and localization of perforator vessels.
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Affiliation(s)
- Gwénael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
| | - Dimitri Gangloff
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Denis Querleu
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Department of Surgical Oncology, Institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Melanie Frigenza
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Juan Jose Torrent
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Departement of Gynecology, Hospital Universitari Germans Trias y Pujol, Carretera de Canyet, 08916 Badalona, Barcelona, Spain
| | - Laetitia Picaud
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Laurence Gladieff
- Departement of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Martine Delannes
- Departement of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Eliane Mery
- Department of Surgical Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Berenice Boulet
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Gisele Balague
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
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Huffman LB, Randolph LK, McCann GA, Billingsley C, Hopkins MP, Cohn DE, Hundley AF. Options for repair of rectus abdominis myocutaneous perineal/vaginal flap prolapse: A case series. Gynecol Oncol Case Rep 2013; 7:1-3. [PMID: 24624318 PMCID: PMC3895284 DOI: 10.1016/j.gynor.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
Abstract
The VRAM flap is commonly used for perineal and vaginal reconstruction at the time of pelvic exenteration. Prolapse of the VRAM flap may be under reported. We have shown successful repair of VRAM flap prolapse via an obliterative technique and sacral suspension.
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Affiliation(s)
- Laura B Huffman
- Department of Obstetrics and Gynecology, The Wexner Medical Center at the Ohio State University, 395 West 12th Avenue, 5th Floor, Columbus, OH 43210, USA
| | - Laura K Randolph
- Department of Obstetrics and Gynecology, Aultman Hospital, 2600 Sixth Street, Canton, OH 44710, USA
| | - Georgia A McCann
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, 320 West 10th Avenue M210 Starling-Loving Hall, Columbus, OH 43210, USA
| | - Caroline Billingsley
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, 320 West 10th Avenue M210 Starling-Loving Hall, Columbus, OH 43210, USA
| | - Michael P Hopkins
- Department of Obstetrics and Gynecology, Aultman Hospital, 2600 Sixth Street, Canton, OH 44710, USA
| | - David E Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, 320 West 10th Avenue M210 Starling-Loving Hall, Columbus, OH 43210, USA
| | - Andrew F Hundley
- Department of Obstetrics and Gynecology, Division of Urogynecology, The Wexner Medical Center at the Ohio State University, 395 West 12th Avenue, 5th Floor, Columbus, OH 43210, USA
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