Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice.

Raymund E Horch,Andreas Arkudas,Aijia Cai,Ingo Ludolph

doi:10.3390/jpm11111076

Abstract

Non-healing extensive wounds in the perineal region can lead to severe soft tissue infections and disastrous complications, which are not manageable with conservative measures. Specifically in recurrent or advanced pelvic malignancies, irradiation often leads to extensive scarring and wound breakdown, resulting in significant soft tissue defects during surgical tumor excision. Among several surgical options to reconstruct the perineum, the transpelvic vertical rectus abdominis myocutaneous (VRAM) flap has proven to be one of the most reliable methods. Specific modifications of this flap allow an individualized procedure depending on the patient’s needs. We modified this technique to include the urethral orifice into the skin paddle of VRAM flaps in three patients as a novel option to circumvent urinary diversion and maintain an acceptable quality of life.

Highlights

Flaps including Urethral Neo-Orifice.Perineal, genital and vulvar or scrotal defects often occur after infections or cancer treatment and are difficult to handle by conservative measures
We report on the extension of the surgical algorithm in reconstruction of complicated perineal wounds with vertical rectus abdominis myocutaneous (VRAM) flaps, utilizing an extrapelvic or transpelvic route combined with the creation of a neo-urethral orifice into the skin paddle of the VRAM flap in three patients
The technique of harvesting of the VRAM flap and its translocation to the perineal area in an intrapelvic manner has been described in detail [10,21,22]

Summary

Introduction

Genital and vulvar or scrotal defects often occur after infections or cancer treatment and are difficult to handle by conservative measures As for the former, Fournier gangrene, a necrotizing fasciitis of the perineum and external genitals, is a life-threatening disease, which mainly affects male patients. Its main treatment includes aggressive debridement, resulting in extensive soft tissue defects in the perineal region [1] As for the latter, irradiated relapsing vulva, anal or rectal cancer can lead to severe soft tissue infections and disastrous wounds that significantly impede the patients quality of life. In current modern oncological concepts of far advanced cases of pelvic malignancies, chemoradiotherapy is an established therapy It may provide temporary symptomatic relief; it can deteriorate existing wounds [2,3,4,5,6,7]. Neoadjuvant radiotherapy can lead to wound breakdown, urinary and sexual problems, as well as postoperative bowel dysfunction [8]

Methods

Discussion

Conclusion