Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

O’Brien, Andrew; Jadallah, Erin; Chao, Albert H.

doi:10.1002/micr.30592

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…Plastic vulva restoration is essential, especially in cases of total vulvectomy, to restore the woman’s sense of physical wholeness. Reconstructive surgery can preserve the patient’s self-esteem and sense of femininity when conducted to restore both the vulvar architecture and function [ 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience

Muallem

Sehouli

Miranda

et al. 2022

Cancers

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(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and reconstructive surgery after vulvar cancer surgery; (2) Methods: this is a retrospective analysis of prospectively collected data from 2009 to 2021 at a tertiary cancer institution; (3) Results: 177 patients were included in the final analysis (51 patients had primary closure PC and 126 had reconstructive surgery RS). About half (49%) of the PC patients had no co-morbidities (p = 0.043). The RS group had a 45 mm median maximal tumor diameter compared to the PC group’s 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free margins (p = 0.1). Both groups had anterior vulvar excision as the most common surgery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had identical rates of wound healing disorders. In a median follow-up of 39 months; recurrent disease was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of overall survival there was no significant difference between the both groups; (4) Conclusions: reconstructive vulvar surgery enables enhanced complete resection rates of larger vulvar tumors with better anatomical restoration and a comparable wound recovery in comparison to primary closure. This results in a lower recurrence rate despite the increased tumor volume.

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Section: Introductionmentioning

confidence: 99%

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience

Muallem

Sehouli

Miranda

et al. 2022

Cancers

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“…Discussion "Split flap" has been a widely acknowledged technique over the years as it allows precise tailoring and coverage of defects with complex geometric configurations or three-dimensional structures. 5,[17][18][19] Inauspicious defect shapes and sizes could be rearranged to form a desirable harvest target then accurately reassembled with the This article is protected by copyright. All rights reserved.…”

Section: Resultsmentioning

confidence: 99%

“…"Split flap" has been a widely acknowledged technique over the years as it allows precise tailoring and coverage of defects with complex geometric configurations or three-dimensional structures. 5,[17][18][19] Inauspicious defect shapes and sizes could be rearranged to form a desirable harvest target then accurately reassembled with the rotated split segments. This avoids unnecessary trimmed off excess and enables donor site primary closures in which secondary skin graft coverage would be inevitable if a conventional wide elliptical flap was harvested for the overly large defect (►Fig.…”

Section: Discussionmentioning

confidence: 99%

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

Shih,

Chiu,

Jeng

et al. 2024

J Reconstr Microsurg

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Background: Split anterolateral thigh flap is a versatile reconstruction option, yet long underestimated as no practical perforator classification and no optimal strategy were present. Harvesting “capillary non-sizable perforators” could potentially expand flap splits to those with no existing multiple sizable perforators. Concerns over defect characteristics, recipient vessels, pedicle length, and split timing should all be weighted equally in designing the suitable flap. Refinement is thus required to enable precise reconstructions. Methods: All patients undergoing anterolateral thigh flap harvests between 2014 to 2021 performed by a single surgeon were included. The perforator patterns of sizable pedicle, course, origin and further successful flap-split methods were documented. Surgical outcome of flap survival was analyzed. Results: Anatomic variants of 134 (48.4%) dual, 123 (44.4%) single, and 20 (7.2%) no sizable perforators were found in a total of 277 anterolateral thigh flaps. The overall flap survival rate was 97.5%. Flap split was performed in 82 flaps, including 29 single and 5 no sizable perforator cases previously considered “un-splittable”, by utilizing a series of direct skin paddle split, capillary non-sizable perforators harvesting, and flow-through anastomosis technique. Comparable flap survivals were found between split and non-split flaps as well as between split segments supplied by sizable and capillary non-sizable perforators. Primary closure was achieved in 98.9% of the thigh donor sites. Conclusion: A new classification of the common anterolateral thigh flap anatomic variants was proposed and a comprehensive algorithm of split flap strategy was developed along with the innovative “fabricate” concept.

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“…However, there are large variations in the caliber and location of the perforator vessels, and the improper positioning of the perforator fulcrum and intraoperative assessments of the distal blood perfusion of the flap often cause complications, including flap harvest failure, the distal ischemia of long flaps, infection, wound dehiscence, and necrosis (4). The objective detection of flap perfusion in real time is key to flap preparation (5). At present, there are various techniques for locating perforator and detecting flap perfusion, but there are no objective unified standards (6).…”

Section: Introductionmentioning

confidence: 99%

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap

Wanyan¹,

Zhong-ming²,

Zhang³

et al. 2022

Ann Transl Med

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Background: This study sought to explore the application value of indocyanine green angiography (ICGA) in the harvest of multi-angiosome perforator flap and the effect of low molecular weight heparin (LMWH) on the survival of postoperative flap.Methods: Twenty-four SD male rats were selected to construct a three-angiosome perforator flap model with the unilateral iliolumbar artery perforator. They were randomly divided into two groups: the control group was injected with indocyanine green (ICG) into the femoral vein during the operation, and the fluorescence signal was collected and quantitatively analyzed using Real-Time Image Guided System to determine the intraoperative fluorescence imaging length. The experimental group was injected subcutaneously with LMWH (400 U/kg) after 0.5 h postoperatively, and the control group was injected with the same amount of normal saline. The injection was repeated at the same time each day from 0 to 7 days postoperatively. After the flap was sutured in situ, ICGA was performed at 0, 1, 3, 5, and 7 days postoperatively to observe the vascular structure of the two groups of flaps. The flap survival length of the control group was counted at 7 days postoperatively, and the correlation between the intraoperative fluorescence imaging length and the survival length at 7 days postoperatively was calculated. The proportion of distal necrosis of the flaps between the two groups was compared at 7 days postoperatively. Results:The average length of intraoperative fluorescence imaging in the control group was 6.29±0.50 cm, and the survival length of the flap at 7 days postoperatively was 8.24±0.52 cm. The actual survival length was higher than the intraoperative fluorescence imaging length, with a ratio of 1.31±0.08. The difference was statistically significant (P<0.05). At 7 days postoperatively, the flap necrosis ratio of experimental group and control group were 10.92%±1.30% and 19.11%±1.19%, and the flap necrosis ratio of experimental group was lower than that of control group (P<0.001).Conclusions: ICGA can locate the position of perforator, and can be used to predict and observe the length of distal survival of multi-angiosome perforator flap postoperatively. LMWH can promote the distal survival of flap and reduce flap necrosis.

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Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

Cited by 3 publications

References 26 publications

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience

Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience

Split Anterolateral Thigh Flap: A New Classification of Anatomical Variants and a Surgical Planning Algorithm

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap

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