Free LD myocutaneous flap provides an adequate solution for reconstruction of pelvic defects resulting from radical oncological resections in cases where the use of locoregional flaps, such as the gluteus maximus flap and the vertical rectus abdominis flap, is not feasible because of an extensive defect, disruption of the vascular pedicle, or due to planning for bilateral stomas placement.
Locally recurrent rectal tumours in the pelvis are found in about 6% following treatment for rectal cancer. This type of tumour can cause serious local complications and symptoms. The aim of modern surgical oncology is to offer a curative treatment option embedded in an interdisciplinary network of specialities to the patient. Due to advancements in surgical techniques and procedures, especially regarding surgical reconstruction, the possibilities of a curative treatment regarding recurrent cancers have been expanded and established. To aim for a curative treatment one must introduce a multimodal therapy including radio- and chemotherapy, and a radical oncological surgery with en bloc resection of the tumour and affected surrounding organs to achieve a R0-resection.
Extended resections of pelvic malignancies, especially in cases of recurrent malignancies, result in the formation of large tissue defects in the region of the pelvic floor and perineum, which are difficult to deal with. Both after extra levator rectal excision and pelvic exenteration, wound healing deficiencies and local infections of the perineal wound are frequent. Primary closure is often impossible due to a lack of tissue substance after resection and an additional previous radiotherapy in most cases. This can result in poor or non-healing wounds, a consecutive need of complex care and an increased risk of secondary problems including tumour recurrences. A permanent wound closure of good quality can therefore only be achieved by plastic surgery. This can be done by local or distant muscle flaps with or without skin, for example, the gluteus maximus flap, the vertical rectus abdominis muscle flap (VRAM) or free flaps such as the latissimus dorsi flap.
Background: Recurrent rectovesical fistulas are a serious burden for the affected patient. Depending on the size and location of the fistula, the underlying disease as well as the preceding therapies, a definitive surgical treatment of the fistula should be the main goal. We analysed the technique of the transposition of the gracilis muscle as a therapeutical option. Methods: We analysed data from 3 male patients who were diagnosed with a recurrent rectovesical fistula and were treated by the transposition of the gracilis muscle in the surgical department of Klinikum Oldenburg. Results: All 3 patients suffered from prostate cancer and were already treated by a different surgical approach while one patient had a second recurrence. Complications arose in two cases in the form of fistula recurrence. Conclusion: Our study has shown that the interposition of the gracilis muscle provides an option to treat rectovesical fistulas.
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