Perineal reconstruction with an extrapelvic vertical rectus abdominis myocutaneous flap.

摘要: Objectives: Extensive perineal resections often require autologous tissue reconstruction, especially in wide oncological resections. Local and regional pedicled flaps from the lower extremity abdominal sites have been described. Defects of pelvis perineum rarely free-tissue transfer. The vertical rectus abdominis myocutaneous (VRAM) flap, traditionally delivered to through an intraperitoneal transpelvic route, is a workhorse flap for combined pelvic defects because its ability provide substantial coverage perineum, reliable vascular supply, larger volume obliterate dead space. We propose describe extended VRAM vulvar reconstruction extrapelvic fashion. Methods: A 54-year-old woman with prior history anal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy followed by abdominoperineal resection, total hysterectomy, bilateral salpingo-oophorectomy. Three years later, she developed lymphatic invasion radical vulvectomy distal urethrectomy. resection defect was 10 × 15 cm, including 1 cm urethra, vaginal orifice, exposure pubic bone. An used reconstruction. Results: harvested transposed into via suprapubic subcutaneous tunnel. neovaginal urethral orifice created splitting muscle direction fibers, taking care protect pedicle, inset orifice. There were no postoperative complications. She has maintained urinary continence follow-up 38 months. Conclusions: Introduction route preferred if laparotomy not resection. successfully report advocate use