Document Detail


Rectus abdominis myocutaneous flaps for neovaginal reconstruction after radical pelvic surgery.
MedLine Citation:
PMID:  15882183     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of this article is to compare the flap-specific complications associated with vertical (VRAM) and transverse (TRAM) rectus abdominis myocutaneous flap vaginal reconstructions performed during radical pelvic procedures. A retrospective chart review was performed to identify all patients who underwent VRAM and TRAM neovaginal reconstructions performed on the Gynecologic Oncology Service at Duke University Medical Center. Flap-specific complications were compared between the two techniques. From 1988 to 2003, 14 VRAM and 18 TRAM flap neovaginal reconstructions were performed on 32 women during the course of 22 (68%) total pelvic exenterations, 8 (25%) partial exenterations, and 2 (6%) radical vulvovaginectomies. Twenty-eight (88%) patients had been previously treated with radiation therapy or concurrent chemoradiation. Associated procedures included continent urinary conduit in 21 (66%), rectosigmoid reanastomosis in 8 (25%), and intraoperative or postoperative sidewall radiation therapy in 7 (22%) of patients. Overall median survival was 14 months (range: 2-week postoperative death to 65 months), with two (6%) acute postoperative mortalities. Fifteen flap-specific complications occurred in 12 (38%) patients, with no significant differences in flap type. Abdominal wound complications included four (12%) superficial wound separations, while one (3%) patient had a fascial dehiscence associated with complex fistulas that contributed to her death, but no patient developed incisional hernia. One patient each developed > 50% flap loss after TRAM and < 50% flap loss after VRAM flap, respectively. Four (12%) patients developed vaginal stricture or stenosis, two (6%) required percutaneous drainage of pelvic abscess or hematoma, and two (6%) developed rectovaginal fistula. Univariate analysis revealed a trend for increasing flap loss with body mass index > 35 (P = 0.056, Fisher exact two-tailed test), but there were no significant associations with other patient characteristics or flap-specific complications. Thirteen (62%) of 21 patients who survived >12 months reported coitus. Both VRAM and TRAM are reliable techniques for neovaginal reconstructions after radical pelvic surgery and have a similar distribution of flap-specific complications involving the donor and recipient sites.
Authors:
J T Soper; L J Havrilesky; A A Secord; A Berchuck; D L Clarke-Pearson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of gynecological cancer : official journal of the International Gynecological Cancer Society     Volume:  15     ISSN:  1048-891X     ISO Abbreviation:  Int. J. Gynecol. Cancer     Publication Date:    2005 May-Jun
Date Detail:
Created Date:  2005-05-10     Completed Date:  2005-07-29     Revised Date:  2006-11-07    
Medline Journal Info:
Nlm Unique ID:  9111626     Medline TA:  Int J Gynecol Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  542-8     Citation Subset:  IM    
Affiliation:
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA. soper001@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Body Mass Index
Female
Genital Neoplasms, Female / surgery*
Humans
Middle Aged
Muscle, Skeletal / surgery
Pelvic Exenteration*
Postoperative Complications*
Reconstructive Surgical Procedures / methods*
Retrospective Studies
Surgical Flaps*
Survival Analysis
Vagina / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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