Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Vaginal Reconstruction
Clinical Presentation
A 68-year-old Asian woman had radiation therapy for early-stage cervical cancer about 40 years ago in Asia and remained cancer free for a long time but unfortunately developed recurrent cervical cancer. She was offered an anterior pelvic exenteration by the gynecological oncology service and an ileal conduit by the urology service. The plastic surgery service was asked to perform a vaginal reconstruction after anterior pelvic exenteration and ileal conduit. She was prepared for multiple surgical procedures in the same setting by three surgical services, each performing a specialty procedure for an optimal outcome ( Fig. 37.1 ).
Operative Plan and Special Considerations
A vertical rectus abdominis myocutaneous (VRAM) flap is a classic option for vaginal reconstruction and soft tissue filling of the dead space within the pelvic cavity. With an appropriate design, the flap can carry a sizable skin paddle for the vaginal reconstruction but only sacrifice a small amount of the anterior rectus sheath if perforators can be identified and incorporated within the skin paddle. The flap can be completely elevated and tunneled through the pelvis to fill the dead space within the pelvic cavity and a reconstructed vagina, formed by folding the skin paddle of the flap into a tube, can be brought out for closure of the perineal wound at the same time. If a smaller amount of the anterior rectus sheath is harvested with the flap, the actual fascial defect can be closed and no mesh is needed for the abdominal donor site closure.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here