Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap

Ludolph, Ingo; Apel, Hendrik; Horch, Raymund E.; Beier, Justus P.

doi:10.1111/iju.12545

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…For treatment of this rare entity, microsurgical free flap transplantation can become necessary, especially to avoid an additional weakening of the abdominal wall using the contralateral rectus abdominal muscle. A combined bipedicular latissimus dorsi/anterior serrate flap is capable of covering the intrapelvic defect (bladder vault using the part of serratus flap) as well as the abdominal wall defect cranial to the symphysis (using the part of latissimus dorsi flap) ( 42 ).…”

Section: Combined Intra- and Extrapelvic Defectsmentioning

confidence: 99%

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Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

et al. 2015

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Defects of the perineum may result from ablative procedures of different malignancies. The evolution of more radical excisional surgery techniques resulted in an increase in large defects of the perineum. The perineogenital region per se has many different functions for urination, bowel evacuation, sexuality, and reproduction. Up-to-date individual and interdisciplinary surgical treatment concepts are necessary to provide optimum oncological as well as quality of life outcome. Not only the reconstructive method but also the timing of the reconstruction is crucial. In cases of postresectional exposition of e.g., pelvic or femoral vessels or intrapelvic and intra-abdominal organs, simultaneous flap procedure is mandatory. In particular, the reconstructive armamentarium of the plastic surgeon should include not only pedicled flaps but also free microsurgical flaps so that no compromise in terms of the extent of the oncological resection has to be accepted. For intra-abdominally and/or pelvic tumors of the rectum, the anus, or the female reproductive system, which were resected through an abdominally and a sacrally surgical access, simultaneous vertical rectus abdominis myocutaneous (VRAM) flap reconstruction is recommendable. In terms of soft tissue sarcoma of the pelvic/caudal abdomen/proximal thigh region, two-stage reconstructions are possible. This review focuses on the treatment of perineum, genitals, and pelvic floor defects after resection of malignant tumors, giving a distinct overview of the different types of defects faced in this region and describing a number of reconstructive techniques, especially VRAM flap and pedicled flaps like antero-lateral thigh flap or free flaps. Finally, this review outlines some considerations concerning timing of the different operative steps.

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Section: Combined Intra- and Extrapelvic Defectsmentioning

confidence: 99%

“…Reconstruction of combined intra- and extrapelvic defects is always very challenging. The literature describes no patent remedy, so we suggest for treatment of this rare entity microsurgical free flap transplantation ( 42 , 43 ).…”

Section: Combined Intra- and Extrapelvic Defectsmentioning

confidence: 99%

Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

et al. 2015

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“…VVF, the most common cause of obstetric fistula frequently follows prolonged obstructed labour. VCF, on the other hand are mostly iatrogenic [3] [5].…”

Section: Discussionmentioning

confidence: 99%

“…Whereas vesico-vaginal fistula (VVF) is the most common type of urinary fistula [1], vesico-cutaneous fistula (VCF) is rare [3], a combination of the two is exceptionally rare.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Combined Vesico-Vaginal and Vesico-Cutaneous Fistulae Treated by One-Stage Surgical Repair

Lengmang¹,

Oseni-Momodu²,

Ushie³

et al. 2017

OJOG

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Combined vesico-vaginal and vesico-cutaneous fistulae are exceptionally rare. We present a young woman who had combined vesico-vaginal fistula and vesico-cutaneous fistula following prolonged obstructed labour and caesarean section. The patient presented at three months of illness with total urine incontinence from the vagina and lower abdominal skin. One-stage surgical repair of both fistulae was done. The patient had a successful closure of the fistulae, regained full urinary continence, and remained continent at six months follow-up. We opine that one-stage repair of combined vesico-vaginal and vesico-cutaneous fistulae is feasible and preferred. Providers of pelvic surgery in low resource countries should be supervised and retrained accordingly, in order to prevent iatrogenic vesico-cutaneous fistula.

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Komplikationsvermeidung in der onkologischen Chirurgie der Becken-/Leistenregion

Beier

Croner

Lang

et al. 2015

Chirurg

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Prevention of perioperative and postoperative complications resulting from surgical oncology in the pelvic region remains a major interdisciplinary challenge. With modern interdisciplinary concepts joining forces of various surgical specialties, tumor resection can be sufficiently carried out with wide margins and the patients benefit from reduced morbidity even in complex situations. As an example chronic fistulation and secretion from the presacral cavity and sinus may result as potential sequelae from intra-abdominal and intrapelvic tumor resection, especially when neoadjuvant multimodal therapies have been applied. This can be prevented by simultaneous transplantation of for example transpelvic vertical rectus abdominis myocutaneous (VRAM) flap transfer, while extensive perineal skin and soft tissue defects may also be simultaneously reconstructed. In cases of malignant soft tissue tumors in the pelvic region a staged surgical procedure can be performed with a period of time between tumor resection and reconstruction. Thus, a histological R0 status can be secured prior to plastic reconstruction surgery in order to increase oncological safety. In cases of postresectional exposition of e. g. pelvic or femoral vessels or intrapelvic and intra-abdominal organs simultaneous flap procedure is mandatory.The reconstructive armamentarium of the plastic surgeon should contain not only pedicled but also free microsurgical flaps so that no compromise in terms of the extent of the oncological resection has to be accepted. At the same time perioperative and postoperative complications may be avoided and the patient quality of life can be preserved even in more complex cases.

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Treatment of a chronic vesicocutaneous fistula and abdominal wall defect after resection of a soft tissue sarcoma using a bipedicled latissimus dorsi and serratus anterior free flap

Cited by 5 publications

References 10 publications

Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

A Rare Case of Combined Vesico-Vaginal and Vesico-Cutaneous Fistulae Treated by One-Stage Surgical Repair

Komplikationsvermeidung in der onkologischen Chirurgie der Becken-/Leistenregion

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