V263 ROTATIONAL LABIAL AND INFERIOR PUDENDIAL ARTERY BASED INNER THIGH FLAPS IN VAGINAL RECONSTRUCTION

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2013V263 ROTATIONAL LABIAL AND INFERIOR PUDENDIAL ARTERY BASED INNER THIGH FLAPS IN VAGINAL RECONSTRUCTION Forrest Jellison, Gladys Ng, Lisa Rogo-Gupta, Leah Nakamura, Denise Chow, Ja-Hong Kim, Larissa Rodriguez, and Shlomo Raz Forrest JellisonForrest Jellison Los Angeles, CA More articles by this author , Gladys NgGladys Ng Los Angeles, CA More articles by this author , Lisa Rogo-GuptaLisa Rogo-Gupta Los Angeles, CA More articles by this author , Leah NakamuraLeah Nakamura Los Angeles, CA More articles by this author , Denise ChowDenise Chow Los Angeles, CA More articles by this author , Ja-Hong KimJa-Hong Kim Los Angeles, CA More articles by this author , Larissa RodriguezLarissa Rodriguez Los Angeles, CA More articles by this author , and Shlomo RazShlomo Raz Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1646AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The rotational inner thigh flap is well vascularized, maintains sensation, and provides reliable cosmetic and functional results for complex vaginal reconstruction. The purpose of this video is to describe the technique with the rotational flap. METHODS All women, from 2002–2012, requiring vaginal reconstruction were retrospectively reviewed. Patients who had a rotational inner thigh flaps performed were included in this analysis. Demographics, pre-operative and operative findings, postoperative sexual function and validated body image perception questionnaire, recurrence of vaginal fistula, or vaginal stenosis were analyzed. RESULTS A total of 486 women underwent vaginal reconstructive procedures of which 30 patients required rotational inner thigh flaps. Indications were vaginal defects that were difficult to access and or required large amount of coverage. The flap was utilized for (7) recurrent vesicovaginal fistula (VVF) repair or (6) rectovaginal fistula (RVF), (14) vaginal stenosis, (6) complex posterior vaginal wall defects, and (13) prior radiation. The median number of prior surgeries was 3. The operative times (mean 173 minutes + 59), EBL (193 + 92 mL), median LOS (3 days), and perioperative complication (6%- superficial soft tissue infection (1), blood transfusion (1) were observed. Graft survival was 100% and all had good cosmesis with no dehiscence. Successful repair of VVF or RVF occurred in 13 (100%) with 8 (62%) requiring 1 surgery, and 5 (38%) two operations. Those that failed primary repair with recurrent VVF (1) and RVF (4) had a history of radiation in 3 (60%) and bowel diversion was not performed in 3 out of the 4 RVF (75%). Complex posterior defects were successfully repaired in all patients (6) with one patient developing vaginal stenosis. Vaginal depth and width were adequate in 82% overall, with 93% (13) patients with vaginal stenosis successfully repaired. Sexual function was maintained in all except 2 patients. Post-operatively patients completed the body image disturbance questionnaires (BIDQ) which examines negative body image. Patient post-operative body image was maintained with a low (BIDQ) score of 1.96 +.92 which is comparable to the non-surgical general population with a 30% response rate. CONCLUSIONS The rotational inner thigh flap is a versatile option for complex vaginal reconstruction. Reliable functional and cosmetic results are achieved while maintaining body image with minimal morbidity. Not performing fecal diversion and a history of radiation were associated with risk of recurrence of fistula. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e108 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Forrest Jellison Los Angeles, CA More articles by this author Gladys Ng Los Angeles, CA More articles by this author Lisa Rogo-Gupta Los Angeles, CA More articles by this author Leah Nakamura Los Angeles, CA More articles by this author Denise Chow Los Angeles, CA More articles by this author Ja-Hong Kim Los Angeles, CA More articles by this author Larissa Rodriguez Los Angeles, CA More articles by this author Shlomo Raz Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...