Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration

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Abstract

BACKGROUND: Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap.

METHODS: Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non-flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated.

RESULTS: Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non-flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non-flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042).

CONCLUSIONS: This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

Original languageEnglish
Pages (from-to)576-583
Number of pages8
JournalAnnals of Plastic Surgery
Volume81
Issue number5
DOIs
Publication statusPublished - Nov 2018

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Pelvic Exenteration
Rectus Abdominis
Quality of Life
Myocutaneous Flap
Coitus
Wound Healing
Demography

Cite this

@article{8ee118ef9ca14c61aa925c3fa452b8a5,
title = "Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration",
abstract = "BACKGROUND: Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap.METHODS: Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non-flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated.RESULTS: Eleven (68.8{\%}) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3{\%}) are still alive. Early complications were reported in 7 patients (43.8{\%}), with 2 (12.5{\%}) flap-related and 5 (31.3{\%}) non-flap-related complications. Similarly, late complications were reported in 5 patients (31.3{\%}), with 2 (12.5{\%}) flap-related and 3 (18.8{\%}) non-flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042).CONCLUSIONS: This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.",
author = "Umberto Cortinovis and Laura Sala and Stefano Bonomi and Gianfrancesco Gallino and Filiberto Belli and Antonino Ditto and Fabio Martinelli and Giorgio Bogani and {Leone Roberti Maggiore}, Umberto and Francesco Raspagliesi",
year = "2018",
month = "11",
doi = "10.1097/SAP.0000000000001578",
language = "English",
volume = "81",
pages = "576--583",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration

AU - Cortinovis, Umberto

AU - Sala, Laura

AU - Bonomi, Stefano

AU - Gallino, Gianfrancesco

AU - Belli, Filiberto

AU - Ditto, Antonino

AU - Martinelli, Fabio

AU - Bogani, Giorgio

AU - Leone Roberti Maggiore, Umberto

AU - Raspagliesi, Francesco

PY - 2018/11

Y1 - 2018/11

N2 - BACKGROUND: Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap.METHODS: Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non-flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated.RESULTS: Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non-flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non-flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042).CONCLUSIONS: This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

AB - BACKGROUND: Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap.METHODS: Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non-flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated.RESULTS: Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non-flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non-flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042).CONCLUSIONS: This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

U2 - 10.1097/SAP.0000000000001578

DO - 10.1097/SAP.0000000000001578

M3 - Article

VL - 81

SP - 576

EP - 583

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 5

ER -