GYNECOLOGIC RECONSTRUCTION WITH A RECTUS-ABDOMINIS MYOCUTANEOUS FLAP - AN UPDATE

This series reports the outcomes and significant complications associa ted with the rectus myocutaneous flap when used for pelvic or inguinal reconstruction in patients with gynecologic cancers, Perioperative va riables were retrospectively reviewed to identify social and medical r isk factors as well as intraoperative and postoperative complications that predisposed to rectus flap failure. Fifteen patients with gynecol ogic malignancies underwent reconstructive procedures using a vertical ly oriented rectus abdominis myocutaneous flap for either vaginal (n = 14) or inguinal (n = 1) reconstruction, The patients' primary cancers were cervical (n = 41), rectal (n = 1), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1). The median age was 50 years, The median follo w-up was 17 months, All flaps were mobilized in conjunction with a rad ical salvage operation, There were no cases of vaginal prolapse and no abdominal wound infections, However, 4 patients (27%) had major posto perative morbidity in this small series. There was one wound dehiscenc e and three episodes of necrosis of the subcutaneous and cutaneous por tions of the flap. All 4 of these patients required additional operati ve intervention or debridement. Eleven patients had complete healing o f the flap. The rectus abdominis myocutaneous flap is a valuable optio n for gynecologic reconstructive procedures, Perioperative strategies for improving flap viability include the identification of risk factor s that may compromise flap perfusions such as prior abdominal incision s, peripheral vascular disease, and obesity, Meticulous surgical techn ique is required to preserve the vascular pedicle, These strategies ma y be useful in preoperative counseling, the perioperative evaluation, and the intraoperative management. (C) 1996 Academic Press, Inc.