Reconstruction of perineum after extended apra and infralevatoric pelvic exenteration.

摘要

Complications after regular surgical closure for irradiated abdominoperineal resection(APRA) and infralevatoric pelvic excenterations (TIPE) are due to non collapsible dead space, use of irradiated skin for closure and infection. Reconstructive options must address the dead space and introduce well vascularised locoregional tissues. When the posterior vaginal wall has been resected with the tumor, this area also needs to be restored in continuity. Since long bilateral myocutaneous gracilis flaps have been considered as the workhorse for such large defects. However, these flaps do not manage to fill a deeper cavity efficiently and the longitudinally aligned skin island is randomly vascularised. Furthermore, in order to obtain a symmetric alignment of tissues, a bilateral flap is mandatory.