Perineal, vulval and vaginoperineal reconstruction using the rectus abdominis myocutaneous flap

Poor perineal healing is a major complication of total or partial pelvic exenteration especially when the pelvis and perineum have previously been irradiated. Perineal, vulval or vaginoperineal reconstruction was performed in five women using the inferiorly based rectus abdominis myocutaneous flap. Primary perineal wound healing occurred in all patients and no flap‐related complications developed. Primary healing of abdominal wall wounds occurred in all patients without incisional hernia. Three of the patients had an anterior or total pelvic exenteration with continent urinary diversion by the Mitrofanoff technique. Two of the patients had complete vaginal reconstruction and one patient had after‐loading catheters inserted for postoperative interstitial irradiation. The patients were in hospital for 42, 28, 21, 17 and 15 days respectively. The longest stays were associated with training for self‐catheterization of the continent urinary diversion. Median follow‐up was 9 months. One patient developed two perineal recurrences at 16 months which were resected, and she remains disease‐free 6 months later.

[1]  Mark R. Young,et al.  Rectus abdominis muscle flap for persistent perineal sinus , 1988, The British journal of surgery.

[2]  C. Woodhouse,et al.  The choice of suprapubic continent catheterisable urinary stoma. , 1987, British journal of urology.

[3]  J. Arbeit,et al.  Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas. , 1987, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  B. Scammell,et al.  Delayed perineal wound healing after proctectomy for Crohn's colitis , 1986, The British journal of surgery.

[5]  H. S. Shukla,et al.  The rectus abdominis flap for perineal wounds. , 1984, Annals of the Royal College of Surgeons of England.

[6]  T. K. Hunt,et al.  Coverage of the Infected Wound , 1983, Annals of surgery.

[7]  S. Parkash,et al.  Rectus abdominis myocutaneous flap—clinical experience with ipsilateral and contralateral flaps , 1983, The British journal of surgery.

[8]  L. Hughes,et al.  The rectus abdominis myocutaneous island flap in breast cancer , 1983, The British journal of surgery.

[9]  M. Kalisman,et al.  Anal sphincter reconstruction and perineal resurfacing with a gracilis myocutaneous flap , 1981, Diseases of the colon and rectum.

[10]  J. Craver,et al.  Infected Median Sternotomy Wound Successful Treatment by Muscle Flaps , 1980, Annals of surgery.

[11]  J. Goligher,et al.  A controlled clinical trial of three different methods of perineal wound management following excision of the rectum , 1975, The British journal of surgery.

[12]  G. Oates,et al.  Management of the pelvic space after proctectomy , 1974, The British journal of surgery.

[13]  R. Prescott,et al.  Perineal wound healing in ulcerative colitis , 1969, The British journal of surgery.

[14]  A. Papaioannou.  Abdominoperineal resection of the rectum. Preliminary experience with a simplified technic. , 1969, American journal of surgery.

[15]  C. Woodhouse,et al.  The Mitrofanoff principle for continent urinary diversion. , 1989, British journal of urology.

[16]  A. Watson.  Atlas of muscle and musculocutaneous flaps , 1988 .

[17]  J. Bauer,et al.  Proctectomy for inflammatory bowel disease. , 1986, American journal of surgery.

[18]  C. P. Page,et al.  Closure of the pelvic and perineal wounds after removal of the rectum and anus , 1980, Diseases of the colon and rectum.

[19]  H. Labandter.  The gracilis muscle flap and musculocutaneous flap in the repair of perineal and ischial defects. , 1980, British journal of plastic surgery.

[20]  G. Crile,et al.  Primary closure of the posterior wound after combined abdominoperineal resection for carcinoma of the rectum. , 1950, Cleveland Clinic quarterly.

[21]  W. Miles.  Technique of the radical operation for cancer of the rectum , 1914 .