Pudendal Thigh Fasciocutaneous Perforator Flap for Vaginal and Perineal Reconstruction: Optimizing Flap Survival
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چکیده
Hypothesis / aims of study Urogenital reconstructive techniques include perineal reconstruction, vaginoplasty, urethral reconstruction, and vesico-vaginal (VVF) and recto-vaginal fistula (RVF) repair. Many of these procedures require the use of local or distant flaps for reconstruction, of which the pudendal thigh fasciocutaneous perforator (PTF) flap is an option. We frequently use this flap for perineal reconstruction, and VVF and RVF fistula repair. It is easy to harvest, sensate, less bulky than myocutaneous flaps, has an inconspicuous donor site scar and has the option of providing an epidermal layer (a major advantage over the Martius graft). However, flap survival rates are highly unpredictable with apical necrosis being widely reported. The aim of this study was to conduct a detailed cadaveric dissection along with angiography to evaluate the perineal blood supply of the PTF flap. We also aimed to analyze why this graft is traditionally unreliable because of apical necrosis and to optimize the future successful use of the PTF flap.
منابع مشابه
The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction.
Vaginal defects can either be congenital or acquired due to tumor or trauma. The reconstructions are aimed in producing a good physical and functional result with the least donor site morbidity. The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branch of the superficial perineal artery, the continuation of the internal pudendal artery. Although various flaps have b...
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METHODS Patients who underwent abdominoperineal resections for anorectal or vulvovaginal cancer were retrospectively analyzed. We include all the patients who could not be repaired by direct closure due to excessive skin tension. We assessed the different flaps used, the surgical complications rate, wound healing, or the progression to chronic wounds. RESULTS We identified 20 patients who under...
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Low-lying rectal cancers are being treated more frequently with robotic-assisted abdominoperineal resection, obviating the need for laparotomy and the ability to raise vertical rectus abdominis musculocutaneous flaps. For female patients, posterior vaginectomy often accompanies the resection. Combined pudendal thigh flaps as an extension of bilateral gluteus advancement flaps allow for posterio...
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BACKGROUND The anterolateral thigh (ALT) perforator flap has become a popular option for treating soft tissue defects of lower extremity reconstruction and can be combined with a segment of the vastus lateralis muscle. We present a comparison of the use of the ALT fasciocutaneous (ALT-FC) and myocutaneous flaps. METHODS We retrospectively reviewed patients in whom free-tissue transfer was per...
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pattern flap that consists of perforators of three arteries: the external pudendal, superficial femoral, and medial circumflex femoral arteries. The presence of axial vessels from the medial femoral circumflex artery and vein has been demonstrated by transillumination at the time of surgery and by cadaveric study [2,3,5]. Because of the longitudinal axial interconnections of these three vessels...
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