Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap
Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap
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DOI：
10.1016/j.bjps.2014.08.059
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发表时间：
2015-01-01
影响因子：
2.7
通讯作者：
Kuokkanen, Hannu O.
中科院分区：
文献类型：
--
作者：
Kaartinen, Ilkka S.;Vuento, Maarit H.;Kuokkanen, Hannu O.
背景：全盆腔脏器切除术（TPE）是一种罕见的手术，其中盆腔内容物被完全清除。骨盆底和阴道重建的几种选择已经被描述，包括横向腹直肌肌皮（TRAM）或深下腹壁穿支（DIEP）皮瓣。横型股薄肌肌皮瓣是一种游离皮瓣，可用于乳房再造。我们采用带蒂颞肌皮瓣进行TPE术后重建。据我们所知，这是第一次报告，这种方法在literature.Methods：2011年11月至2014年2月，12例患者接受TPE和重建与单侧（6例）或双侧（6例）蒂TMG皮瓣。5例患者接受了双侧TMG皮瓣阴道再造术。我们描述了手术过程和结果的操作在这些patients.Results：总的平均手术时间为TPE或不阴道重建分别为467 +/- 12和386 +/- 59分钟。TMG皮瓣具有足够的血管组织和活动度，可用于修复TPE缺损。18例皮瓣中1例远端坏死，其余全部成活。在后续行动中，完全伤口愈合，没有迹象表明，削弱骨盆floor被观察到在所有cases.Conclusions：软组织重建需要减少与TPE相关的并发症，以确保骨盆底和重建阴道在选择的患者。TMG皮瓣是一个合理的皮瓣选择，不会导致功能缺陷，复杂的腹部造口或削弱腹壁。与腹部皮瓣相比，它缩短了手术时间。(C)2014年英国整形、重建和美容外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Total pelvic exenteration (TPE) is a rare operation in which the pelvic contents are removed entirely. Several options for pelvic floor and vaginal reconstruction have been described including transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps. The transverse musculocutaneous gracilis (TMG) flap has been introduced for breast reconstruction as a free flap. We adopted the pedicled TMG flap for reconstructions after TPE. To the best of our knowledge, this is the first report of this method in the literature.Methods: Between November 2011 and February 2014, 12 patients underwent TPE and reconstruction with unilateral (six patients) or bilateral (six patients) pedicled TMG flaps. Five patients underwent vaginal reconstruction with bilateral TMG flaps. We describe the operative procedure and the outcome of the operation in these patients.Results: The total mean operative times for TPE with or without vaginal reconstruction were 467 +/- 12 and 386 +/- 59 min, respectively. The TMG flaps had enough vascular tissue and mobility for reconstructing the TPE defects. There was distal edge necrosis in one out of 18 flaps, while the rest survived completely. During the follow-up, complete wound healing with no signs of weakening of the pelvic floor was observed in all cases.Conclusions: Soft-tissue reconstructions are needed to reduce complications associated with TPE, to secure the pelvic floor and to reconstruct the vagina in select patients. The TMG flap is a logical flap choice that does not lead to functional deficits, complicate the abdominal ostomies or weaken the abdominal wall. It reduces the length of operation compared to that of abdominal flaps. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.