Surgeon’s workshopBilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds
Section snippets
Case report
A 35-year-old female patient who had been initially treated by conization and succeeding hysterectomy because of cervical carcinoma presented with vesicovaginal and pouch-vaginal fistulas. Because of local recurrence, she had undergone intravaginal local afterloading radiotherapy (40 Gy) four times, causing an extended fistula between the posterior vaginal wall and rectum. Multiple different approaches to close the fistula by direct repair had failed within weeks. She finally underwent
Operative procedure
To close both fistulas, we performed laparotomy, with careful separation of the small bowel loops and revision of the defects using an abdominovaginal approach with the patient in the lithotomy position. A left-sided, inferiorly based, vertical rectus abdominis myocutaneous flap was elevated (Fig. 2A). The hood of the skin paddle of the flap was sutured together to form a dome-like reservoir structure mimicking the vaginal dome (Fig. 2B). The flap was pulled through the pelvis to cover the
Comment
In addition to the obvious psychosocial benefit to the patient and her partner, the incorporation of viable tissue into the pelvic cavity decreases the incidence of infection and small bowel complications. Pelvic and genitoperineal irradiation is an adjunctive or primary option in the treatment of pelvic malignancies. However, it can add to the problems of wound healing, destroy normal anatomy and function, and have a severe effect on the postablative reconstructive process.7 Reconstructive
Conclusions
The outcome for the patient was a satisfactory functional vagina that was technically easy to construct. The operation is straightforward, quick, and safe. The rectus abdominis myocutaneous flap can provide an adequate neovagina with minimal morbidity even when previous surgical incisions exist.
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2019, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Complications have been reported in 37.5% to 67% of cases [19,30,39]. While the vertical rectus abdominis myocutaneous (VRAM) flap [11,20,21,40–42] is a potential coverage option, donor site morbidity is very high. It requires that the abdominal wall be reconstructed with synthetic material.
Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: A report on two cases
2015, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :Various tissue grafts can be used in both vaginal (labial fat pad and gracilis muscle) and abdominal repair (peritoneum, omentum, and myocutaneous muscle flaps). These grafts improve local vascularity, absorb urinary extravasate, and prevent leakage of urine from the bladder [5]. However, 5–10% of VVFs recur after the primary repair.
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