Internal Pudendal Artery Perforator Island Flap for Management of Recurrent Benign Rectovaginal Fistula

Khalil, Haitham; Malahias, Marco; Karandikar, Sharad; Hendrickse, Charles

doi:10.1097/gox.0000000000000850

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…M y colleagues and I would like to thank the researchers for their interest 1 in our study. 2 Although we agree that the named pedicle is the same, there are differences in the design and the technique of the Internal Pudendal Artery Perforator (IPAP) flap harvesting in this study compared with the studies mentioned in the comments. In our series, we presented a 3-dimensional insetting of the island IPAP flap to reconstruct 2 components, including the potential space in the rectovaginal septum after fistulectomy and the perineal skin deficiency simultaneously utilizing the multizone (3 zones) design (Figs.…”

mentioning

confidence: 58%

Reply: Suprafascial 3 Zone Dissection of Internal Pudendal Artery Perforator Flap for Management of Rectovaginal Fistula

Khalil

Malahias

Karandikar

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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confidence: 58%

Reply: Suprafascial 3 Zone Dissection of Internal Pudendal Artery Perforator Flap for Management of Rectovaginal Fistula

Khalil

Malahias

Karandikar

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…1,2,15,16,[23][24][25]30,31 Notably, other recognized perineal perforated flaps as internal pudendal artery perforator flaps are used; however, they were more suitable for small to moderate perineal defects. 31,32 In addition, their reliability has been questioned because they have been directly situated in the zone of the radiotherapy field when used for perineal reconstruction after oncological resection. 11 Compared with conventional V-Y flaps, the IGAP flaps provide extensive skin mobilization to cover large defects.…”

Section: Discussionmentioning

confidence: 99%

Sacroperineal Reconstruction With Inferior Gluteal Artery Perforator Flaps After Resection of Locally Advanced Primary and Recurrent Anorectal Malignancy

et al. 2022

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Modern interdisciplinary concepts with involvement of various surgical specialties can considerably reduce perioperative morbidity after sacroperineal resection of locally advanced primary or recurrent anorectal malignancies. Resultant defects can represent a major challenge for reconstruction particularly with chemoradiotherapy. The aim is to assess the long-term outcomes of sacroperineal reconstruction using inferior gluteal artery perforator flaps.We performed a retrospective data analysis on 31 patients who were treated with inferior gluteal artery perforator flaps (n = 61) over the period 2009-2021. The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection and dehiscence were recorded.The median age was 42 year (range, 25-82 years) with preponderance of males (n = 21). The follow-up period ranged from 6 to 80 months. Early minor complications included superficial wound dehiscence (3), which was managed conservatively, whereas the major (2) included deep wound collection and infection (1), which required surgical drainage, and perineal hernia, which required repair. All flaps survived completely.Inferior gluteal artery perforator flaps are safe, robust, and reliable with less donor side morbidity and positive impact on quality of life. It should be considered as a valuable tool in the reconstructive armamentarium of sacroperineal defects within a multidisciplinary setting.

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“…Subsequently, IPAP flaps have been widely studied and proved to be a reliable choice for repairing RVFs. 6,8,13,14 However, postoperative dryness during sexual activity and the presence of hair in the vagina have been observed in follow-up cases. 14 A negative effect on sexual life in patients having undergone tissue interposition was also reported in the literature.…”

Section: Why This Mattersmentioning

confidence: 99%

“…Despite numerous surgical approaches available for treatment, LRVF still presents a reconstructive challenge, with high failure rates 3 . The interposition of well-vascularized healthy tissue, including a variety of muscles and pedicled adipose tissue, has been shown to be a successful approach for repairing LRVF 3–7 …”

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Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula

Yuan,

Li,

et al. 2024

UROGC

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Importance Rectovaginal fistula (RVF) is a challenging condition associated with recurrences and significant functional impairment. Objectives The internal pudendal artery perforator (IPAP) flap has become a viable option for reconstructing the vagina and perineal regions. This study aims to introduce a modified technique of IPAP flap interposition and evaluate its postoperative outcomes in the treatment of low RVF. Study Design Sixteen patients with RVF who underwent modified IPAP flap interposition between 2016 and 2021 were retrospectively enrolled. Recurrence rate, the satisfaction of vulvar appearance (Visual Analog Scale), and quality of sexual life (Female Sexual Function Index score) were followed up and analyzed. Results All patients presented with low fistula with a mean diameter of 8.3 mm. The mean width and length of the IPAP flaps were 3.8 and 6.2 cm, respectively. The mean follow-up period was 14.1 months. All patients achieved successful healing without recurrence. High satisfaction was reported for the cosmetic effect of the vulva with a mean Visual Analog Scale score of 8.4. The proportion of female sexual disorder exhibited a statistically significant reduction, decreasing from 100% preoperatively to 38% after surgery (P < 0.05). Conclusions The modified IPAP flap interposition is a reliable and safe option for repairing low RVF, with high success rates and minimal donor site morbidity. Moreover, this procedure provides a suitable volume flap and preserves the vaginal physiological environment, which benefits postoperative sexual function.

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Internal Pudendal Artery Perforator Island Flap for Management of Recurrent Benign Rectovaginal Fistula

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 10 publications

Reply: Suprafascial 3 Zone Dissection of Internal Pudendal Artery Perforator Flap for Management of Rectovaginal Fistula

Reply: Suprafascial 3 Zone Dissection of Internal Pudendal Artery Perforator Flap for Management of Rectovaginal Fistula

Sacroperineal Reconstruction With Inferior Gluteal Artery Perforator Flaps After Resection of Locally Advanced Primary and Recurrent Anorectal Malignancy

Modified Internal Pudendal Artery Perforator Flap Interposition for Rectovaginal Fistula

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