Resurrection of the rectus abdominis musculoperitoneal flap for pelvic exenteration?
نویسنده
چکیده
Becoming aware of the article of Cibula et al. (Cibula et al., 2017) entitled “Pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after pelvic exenterations” in Gynecologic Oncology made me curious: Has the rectus musculoperitoneal flap, a slimmed version of the transversus and rectus abdominis musculoperitoneal flap developed by us 20 years ago (Höckel, 1996; Konerding et al., 1997), resurrected as an effective adjuvant in pelvic exenterative surgery? Unfortunately, reading the complete paper was quite disappointing. The authors retrospectively compared 24 historical pelvic exenterations performed in their institution without pelvic floor reconstruction with 13 pelvic exenterations and 3 “ELSE” procedures that received “modified” rectus abdominis myoperitoneal flaps for pelvic floor reconstruction and found less reoperation and postoperative complication rates. Cibula et al. on one hand expect that the readers know what ELSE is and what is meant by the attribute “modified”, although no literature references are provided. On the other hand, they assume that the readers are not familiar with the surgical principles and the anatomy of rectus abdominis myo(musculo-) peritoneal flaps despite previous publication in detail (Höckel, 1996; Konerding et al., 1997). Likewise, it is confusing that the authors use a “historic” (2007–2012?) cohort without pelvic floor reconstruction as control group. It is hardly imaginable that exenterative surgeons of the 21st century do not generally apply means to fill and cover the more or less empty pelvis. Transferring non-irradiated angiogenic tissue into the pelvic cavity and hiatus genitalis had been demonstrated decades ago as most effective way to reduce postoperative mortality and morbidity in exenterative surgery (Buchsbaum and White, 1973; Soper et al., 1989). From our long-term experience with laterally extended endopelvic resection (LEER) for locally advanced and recurrent malignancies of the lower female genital tract we found omentum majus flaps combined with pudendal thigh, gracilis or gluteal thigh flaps most suitable to cover the pelvic side walls and fill completely any dead space in addition to reconstruct the pelvic floor, cutaneous perineum, vulva and eventually vagina (Höckel et al., 2012; Höckel, 2015). Only in the rare situations of missing omentum majus we have applied and recommend rectus abdominis musculoperitoneal flaps. A prospective study with clearly defined endpoints using either omentum majus/thigh flap combinations versus abdominal wall musculoperitoneal flaps would have made the resurrection of the rectus abdominis musculoperitoneal flap more “believable”.
منابع مشابه
Comparison of the Complications in Vertical Rectus Abdominis Musculocutaneous Flap with Non-Reconstructed Cases after Pelvic Exenteration
BACKGROUND Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes ...
متن کاملOptions for repair of rectus abdominis myocutaneous perineal/vaginal flap prolapse: A case series☆
•The VRAM flap is commonly used for perineal and vaginal reconstruction at the time of pelvic exenteration.•Prolapse of the VRAM flap may be under reported.•We have shown successful repair of VRAM flap prolapse via an obliterative technique and sacral suspension.
متن کاملReconstruction with rectus abdominis myocutaneous free flap after orbital exenteration in children.
OBJECTIVE To present a 1-stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in children. SURGICAL TECHNIQUE After orbital exenteration, a myocutaneous rectus abdominis free flap with long vascular pedicle is harvested from the abdomen. The flap is transferred to the orbit and the vascular pedicle is passed through an opening m...
متن کامل[Perineal hernia following abdominoperineal amputation and myocutaneous flap].
Perineal hernia after infralevator posterior pelvic exenteration due to adenocarcinoma of the lower rectum with genital invasion: a rectus abdominis myocutaneous flap was used to repair the defect and reconstruct the vagina. The donor abdominal fascia area was reinforced with bio-absorbable mesh (BioA-Gore). On CT, ileal loops were observed with elongated mesentery in the pelvis and perineum, a...
متن کاملUse of adjuvant techniques improves surgical outcomes of complex vertical rectus abdominis myocutaneous flap reconstructions of pelvic cancer defects.
BACKGROUND Reconstruction of irradiated pelvic defects following oncologic resection requires dead-space obliteration to reduce wound healing complications. Although the vertical rectus abdominis myocutaneous (VRAM) flap is often the best option for pelvic reconstruction following abdominoperineal resection or pelvic exenteration, donor- and recipient-site complications are common. The authors ...
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عنوان ژورنال:
دوره 22 شماره
صفحات -
تاریخ انتشار 2017