A FLAP MODALITY FOR RESURFACING FOLLOWING EXTERNAL GENITALIA TUMOR ABLATION: A CONSECUTIVE CASE SERIES
DOI:
https://doi.org/10.14228/jprjournal.v10i1.358Keywords:
Genitalia external, Reconstruction, FlapAbstract
Introduction : External genitalia defect may result from various cases such as vulvar cancer, cervical cancer, tumor metastases, etc. Female genitalia is challenging for reconstruction due to many complex anatomical structure like urethra, vagina, anus, and its a highly mobile region. It is need to reconstruct with high successful rate and low morbidity procedure. The aim of this paper is to report various flaps for resurfacing following external genitalia defect.
Method : From September 2017 - April 2022, 7 patients referred by Obstetric Gynecology Department to Plastic Surgery Division at Muhammad Hoesin Central General Hospital. The data was reviewed retrospectively to evaluate demographic, diagnosis, choice of flap reconstruction, functional and anatomical long term evaluation.
Result : The ages of the patients ranged from 29 - 67 year-old, diagnosed with cervical cancer with tumor metastases to vulva in 16% (n=1) and vulvar carcinoma 84% (n=5). Flaps performed: Antero-lateral Thigh (ALT) flap in 14,5% (n=1), gracilis flap in 28,5% (n= 2), rotation flap in 28,5% (n= 2), keystone flap in 28,5% (n=1). A major dehiscence and need required reoperation for abscess in 16% (n=1). Flap selection based on size, region, and anatomical structure defect. ALT was chosen for wide and bilateral vulvar and perineal defect, gracilis for unilateral vulvar and perineal defect, Keystone flap for half of vulvar and perineal defect, rotation flap for defect on mons region.
Conclusion: Flap selection in genitalia external reconstruction must be consider on the anatomical loss structure and defect size to achive durable tissue for acceptable functional and mobilisation. The algorithm may help to choose for flap based on loss area.
References
Peiretti, M., Corvetto, E., Candotti, G., Angioni, S., Figus, A., & Mais, V. (2019). New Keystone flap application in vulvo-perineal reconstructive surgery: a case series. Gynecologic Oncology Reports, 100505. doi:10.1016/j.gore.2019.10050 DOI: https://doi.org/10.1016/j.gore.2019.100505
Mericli, A. F., Martin, J. P., & Campbell, C. A. (2016). An Algorithmic Anatomical Subunit Approach to Pelvic Wound Reconstruction. Plastic and Reconstructive Surgery, 137(3), 1004–1017. doi:10.1097/01.prs.0000479973 DOI: https://doi.org/10.1097/01.prs.0000479973.45051.b6
Grubbs H, Manna B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 21, 2022. Wound Physiology.
Ozgok Kangal MK, Regan JP. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2022. Wound Healing.
Wallace HA, Basehore BM, Zito PM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 25, 2022. Wound Healing Phases.
World Union of Wound Healing Societies (WUWHS) Consensus Document. Surgical wound dehiscence: improving prevention and outcomes. Wounds International, 2018
Bacalbasa, Nicolae; Balescu, Irina; Mereuta, Andreea; Tanase, Alina; Ghelmene, Adriana; Vilcu, Mihaela; and Brezean, Iulian (2019) "Gracilis myocutaneous flap for perineal defect reconstruction after left hemivulvectomy for locally invasive vulvar cancer – A case report and a literature review," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 1 , Article 27.
Siegel R, Ward E, Brawley O, Jemal A (2011) Cancer statistics, 2011. CA Cancer J Clin 61:212–236 DOI: https://doi.org/10.3322/caac.20121
SEER Cancer Statistics Factsheets: Vulvar cancer. Bethesda, MD:National Cancer Institute, April 22, 2016
Strauch, B., Vasconez, LO., et al. (2009). Grabb's Encyclopedia of Flaps. Torso, Pelvis, and Lower Extremities. 3rd Edition.
Kolehmainen, M., Suominen, S., & Tukiainen, E. (2013). Pelvic, Perineal and Genital Reconstructions. Scandinavian Journal of Surgery, 102(1), 25–31. doi:10.1177/14574969131020010 DOI: https://doi.org/10.1177/145749691310200106
Srivastav, S., Gupta, S., & Sharma, A. (2020). Keystone Flap as a Reconstructive Option for selected areas; A Prospective Study. Journal of Clinical Orthopaedics and Trauma. doi:10.1016/j.jcot.2020.06.019 DOI: https://doi.org/10.1016/j.jcot.2020.06.019
Bacalbasa, Nicolae; Balescu, Irina; Mereuta, Andreea; Tanase, Alina; Ghelmene, Adriana; Vilcu, Mihaela; and Brezean, Iulian (2019 "Gracilis myocutaneous flap for perineal defect reconstruction after left hemivulvectomy for locally invasive vulvar cancer – A case report and a literature review," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 1 , Article 27.DOI: 10.22543/7674.61.P176180 DOI: https://doi.org/10.22543/7674.61.P176180
Shridharani, S.M. Wang, H.D. 2013. Interesting Case Series Pedicled Anterolateral Thigh Flap for Vaginal and Perineal Reconstruction. Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School ofMedicine, Baltimore, Md.
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