Surgical outcomes of VRAM versus gracilis flaps for the reconstruction of pelvic defects following oncologic resection✰

Stein, Michael J.; Karir, Aneesh; Ramji, Maleka; Allen, Murray; Bain, James R.; Avram, Ronen; Boushey, Robin P.; Auer, Rebecca C.; Jarmuske, Mario

doi:10.1016/j.bjps.2018.12.044

Cited by 42 publications

(51 citation statements)

References 15 publications

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“…There are no prospective studies comparing thigh or abdominal based flaps for pelvic floor and vaginal reconstruction. No differences were detected on outcomes or complications when thigh and abdominal flaps were compared in meta-analysis or recent retrospective studies [15,27,30]. Our overall complication rate of 71.8% was similar to the rates in previous publications [1,9,13]; notably, earlier reports did not always define complication severity.…”

Section: Discussionsupporting

confidence: 79%

“…Harvesting the flap from the abdomen is associated with significant donor site morbidity as it weakens the anterior abdominal wall resulting abdominal wound complication rate up to 48% [16]. Some prefer gracilis flap over abdominal flap when bilateral ostomies are needed [27]. However, there is no clear evidence that use of abdominal flap would increase abdominal herniation risk [15,28] Second, harvesting the TMG flaps and reconstruction of the pelvic floor can be performed while the urologist performs urinary diversion.…”

Section: Discussionmentioning

confidence: 99%

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Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Kiiski

Räikkönen

Vuento

et al. 2019

European Journal of Surgical Oncology

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Introduction: Pelvic exenteration (PE) is the only curative treatment for certain locally advanced intrapelvic malignancies. PE has high morbidity, and optimal reconstruction of the pelvic floor remains undetermined. Materials and methods: A retrospective chart review was performed at a tertiary university center to assess the surgical and oncological outcomes of 39 PE procedures over a 12-year period. The majority of patients (n ¼ 25) underwent transverse musculocutaneous gracilis (TMG) flap reconstruction for pelvic floor reconstruction. Results: The 1-and 5-year overall survival (OS) was 72% (95%CI 58%e86%) and 48% (95%CI 31%e65%), respectively. In multivariate analysis, lymph node metastasis (HR 3.070, p ¼ 0.024) and positive surgical margins (HR 3.928, p ¼ 0.009) were risk factors for OS. In this population, 71.8% of the patients had at least one complication. The complication rate was 65.4% and 84.6% for patients with versus without flap reconstruction, respectively (p ¼ 0.191). The length of stay was longer for patients with a major complication 16,0 ± 5,9 days vs. 29,4 ± 14,8 days, p ¼ 0,001, but complications did not affect OS. Conclusion: For selected patients, PE is a curative option for locally advanced, residual, or recurrent intrapelvic tumors. Pelvic floor and vulvovaginal defects can reliably be reconstructed using TMG flaps. TMG flaps are favored in our institution over abdominal-based flaps because the donor site morbidity is reasonable and TMG does not interfere with enterostomy.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Kiiski

Räikkönen

Vuento

et al. 2019

European Journal of Surgical Oncology

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“…In the study of Sheckter et al [49] no recipient site complications occurred. Nine (23.1%) studies did not make the distinction between minor and major recipient site complications [30,31,39,42,47,54,[57][58][59]. Minor complications were reported in 28.4% of the cases and major complications in 8.7% of the cases.…”

Section: Vram Reconstructionmentioning

confidence: 98%

“…In eight (20.5%) studies, no donor site complications occurred [41,49,[52][53][54][55][56]. Eight (20.5%) studies did not distinguish between minor and major complications for the donor site [5,7,30,31,39,[57][58][59]. In the remaining studies, minor complications were reported more often than major complications (15.2% versus 2.6%).…”

Section: Vram Reconstructionmentioning

confidence: 99%

Lotus petal flap and vertical rectus abdominis myocutaneous flap in vulvoperineal reconstruction: a systematic review of differences in complications

Hellinga

Rots

Werker

et al. 2020

Journal of Plastic Surgery and Hand Surgery

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Background: Vulvoperineal defects resulting from surgical treatment of (pre)malignancies may result in reconstructive challenges. The vertical rectus abdominis muscle flap and, more recently, the fasciocutaneous lotus petal flap are often used for reconstruction in this area. The goal of this review is to compare the postoperative complications of application of these flaps. Methods: A comprehensive literature search of the PubMed, MEDLINE and Cochrane Library databases was performed until 6 June 2020. Search terms included the lotus petal flap, vertical rectus abdominis muscle flap and the vulvoperineal area. Articles were independently screened by two researchers according to the PRISMA-guidelines. Results: A total of 1074 citations were retrieved and reviewed, of which 55 were included for full text analysis. Following lotus petal flap reconstructions, the complication rate varied from 0.0% to 69.9%, with more complications concerning the recipient site compared with the donor site complications (26.0% versus 4.5%). Following vertical rectus abdominis muscle flap reconstructions the complication rate varied between 0.0% and 85.7% with almost twice the number of recipient site complications compared to donor site complications (37.1% versus 17.8%). Conclusions: Overall, the lotus petal flap has lower complication rates at both the donor and the recipient site compared with the vertical rectus abdominis muscle flap. When both options seem viable, the lotus petal flap procedure may be preferred on the basis of the reported lower complication rates.

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“…The procedure leaves a large empty space in the pelvis, often leading to postoperative collections, abscess formation, prolonged ileus, intestinal obstruction and small bowel fistulas, collectively termed empty pelvis syndrome (EPS) [2][3][4]. A number of surgical options [5][6][7][8][9][10][11][12][13] have been suggested to overcome this problem. However, to date, the search for the ideal solution continues.…”

Section: Introductionmentioning

confidence: 99%

Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration

et al. 2020

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Aim Pelvic exenteration is the only surgical option for locally advanced pelvic malignancies infiltrating the surrounding organs. The resultant pelvic void after the procedure is responsible for a number of complications, collectively termed empty pelvis syndrome (EPS). We aim to show how EPS can be minimized by presenting a case series demonstrating the surgical technique of laparoscopic total pelvic exenteration with bilateral pelvic node dissection along with a novel use of the Bakri balloon. Method This is a case series of three successive patients undergoing laparoscopic total pelvic exenteration for locally advanced primary, nonmetastatic rectal adenocarcinoma over a period of 1 month in a specialized colorectal unit at a tertiary cancer centre. The Bakri balloon was deployed in all three patients and retained for variable time intervals postoperatively. Features of EPS were prospectively documented. Results In the first patient, the Bakri balloon was completely deflated and removed on postoperative day (POD) 5. The patient developed subacute intestinal obstruction which resolved with conservative management by POD 12. In the second and third patients, the Bakri balloon was deflated in a sequential manner, beginning on POD 8, until it was finally removed on POD 11. Neither of these patients had any abdominal complaints. A postoperative CT scan of both these patients showed the small bowel loops clearly above the pelvic inlet. Conclusions The Bakri balloon is a simple, safe and cost-effective method to reduce the complications of EPS following laparoscopic total pelvic exenteration. A prospective study is ongoing to objectively quantify the benefits of this technique.

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Surgical outcomes of VRAM versus gracilis flaps for the reconstruction of pelvic defects following oncologic resection✰

Cited by 42 publications

References 15 publications

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Lotus petal flap and vertical rectus abdominis myocutaneous flap in vulvoperineal reconstruction: a systematic review of differences in complications

Novel use of the Bakri balloon to minimize empty pelvis syndrome following laparoscopic total pelvic exenteration

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