Neovagina Reconstruction Utilizing the Bladder and Urethra Following Radical Radiation Therapy

Abstract

Introduction: Radical pelvic radiation therapy can cause severe radiation pelvic fibrosis, necrosis, and fistulas. Vaginal reconstruction in these devascularized and scarred areas is complicated. Case Report: We present a stage IB squamous cell cervical carcinoma patient who was treated elsewhere with radical cancer surgery and radiation therapy. She later presented with radiation fibrosis, ureteral obstruction, and dyspareunia associated with a severely shortened and stenotic vagina. The patient underwent an ileal conduit construction and neovagina reconstruction using the urethra and bladder. When the operation was completed, a 10 ؋ 6 ؋ 6 cm neo-vagina was reconstructed. Regrettably, radiation fibrosis developed again, complicating intercourse for the patient. Conclusion: High-risk vaginal reconstructive surgery may be indicated for gynecologic cancer patients treated with radical radiation or surgery. However, progressive radiation fibrosis remains an ongoing problem for these patients. The use of non-irradiated flaps and grafts is preferable when feasible. (J GYNECOL SURG 22:73)

May the rectus abdominis myocutaneous flap be the best option for the reconstruction of complicated large defects of pelvic exenteration for vulvar malignancies after pelvic radiation?

“…Myocutaneous flaps have some advantages such as providing a good source for neovascularization in irradiated tissues and obliteration of large pelvic defects [10]. Therefore they are more effective as a bulky tissue in the reconstruction of large defects compared to thinner fasciocutaneous flaps [11].…”