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DOI: 10.5999/aps.2014.41.6.722
Comparison of the Complications in Vertical Rectus Abdominis Musculocutaneous Flap with Non-Reconstructed Cases after Pelvic Exenteration
Background Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage.
Methods We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such reconstruction.
Results Flap reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n=9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n=9), peritonitis and bowel obstruction occurred in 1 case (11%).
Conclusions Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate perineal reconstruction to prevent major complications of pelvic exenteration.
Publication History
Received: 08 May 2014
Accepted: 10 July 2014
Article published online:
05 May 2022
© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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References
- 1 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187-196
- 2 Slankamenac K, Graf R, Barkun J. et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013. 258.
- 3 Soper JT, Berchuck A, Creasman WT. et al. Pelvic exenteration: factors associated with major surgical morbidity. Gynecol Oncol 1989; 35: 93-98
- 4 Orr Jr JW, Shingleton HM, Hatch KD. et al. Gastrointestinal complications associated with pelvic exenteration. Am J Obstet Gynecol 1983; 145: 325-332
- 5 Jain AK, DeFranzo AJ, Marks MW. et al. Reconstruction of pelvic exenterative wounds with transpelvic rectus abdominis flaps: a case series. Ann Plast Surg 1997; 38: 115-122
- 6 Ball AB, Cassoni A, Watkins RM. et al. Silicone implant to prevent visceral damage during adjuvant radiotherapy for retroperitoneal sarcoma. Br J Radiol 1990; 63: 346-348
- 7 Mathes SJ, Feng LJ, Hunt TK. Coverage of the infected wound. Ann Surg 1983; 198: 420-429
- 8 McCraw JB, Massey FM, Shanklin KD. et al. Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg 1976; 58: 176-183
- 9 Heath PM, Woods JE, Podratz KC. et al. Gracilis myocutaneous vaginal reconstruction. Mayo Clin Proc 1984; 59: 21-24
- 10 Mathes SJ, Bostwick 3rd J. A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects. Br J Plast Surg 1977; 30: 282-283
- 11 Shukla HS, Hughes LE. The rectus abdominis flap for perineal wounds. Ann R Coll Surg Engl 1984; 66: 337-339
- 12 Kim JT, Ho SY, Hwang JH. et al. Perineal perforator-based island flaps: the next frontier in perineal reconstruction. Plast Reconstr Surg 2014; 133: 683e-687e