Special Role of Plastic Surgery in Approaches to Complex Reoperative Pelvic Operations

Abstract

Reoperative pelvic surgery for fistulae secondary to radiation, inflammation or malignancy is often associated with postoperative infection and healing complications. Seven cases illustrating the management of complex pelvic fistulae are presented with emphasis on the plastic surgical techniques employed. We believe that buttressing fistula repair sites or filling pelvic defects with well-vascularized, nonirradiated tissue facilitates healing and lessens fistula or abscess recurrence despite the presence of contamination. Key factors in successful muscle flap transposition are knowledge of muscle vascular supply, arc of rotation and muscle mass.