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Rectus Abdominis Myofascial Flap for Vaginal Reconstruction After Pelvic Exenteration

Cortinovis, Umberto, MD*; Sala, Laura, MD*; Bonomi, Stefano, MD*; Gallino, Gianfrancesco, MD; Belli, Filiberto, MD; Ditto, Antonino, MD; Martinelli, Fabio, MD; Bogani, Giorgio, PhD; Leone Roberti Maggiore, Umberto, PhD; Raspagliesi, Francesco, MD

doi: 10.1097/SAP.0000000000001578
Reconstructive Surgery

Background Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are available. However, the use of a myofascial flap has not been previously described. Thus, the objective of this article is to present our experience of vaginal reconstruction with rectus abdominis myofascial (RAMF) flap.

Methods Between May 2008 and March 2017, 16 patients underwent anterior, posterior, or total pelvic exenteration with RAMF flap vaginal reconstruction. Patient records were systematically reviewed; demographic, clinic and pathologic, operative details, flap-related and non–flap-related complications, and risk factors for wound healing are reported. Quality of life and sexual function were also investigated.

Results Eleven (68.8%) of 16 patients died during the follow-up (29.1 ± 25 months), whereas 5 (31.3%) are still alive. Early complications were reported in 7 patients (43.8%), with 2 (12.5%) flap-related and 5 (31.3%) non–flap-related complications. Similarly, late complications were reported in 5 patients (31.3%), with 2 (12.5%) flap-related and 3 (18.8%) non–flap-related complications. Quality of life measured by SF-36 (Survey Short Form 36) significantly improved at 12-month follow-up in comparison with baseline (physical component summary 31.5 ± 4.8 vs 26.8 ± 2.9; P = 0.027; mental component summary 29.5 ± 6.0 vs 25.9 ± 2.0; P = 0.042).

Conclusions This study demonstrates for the first time that RAMF flap vaginal reconstruction after pelvic exenteration is an efficacious and safe technique. Furthermore, it is associated with a significant improvement of quality of life and sexual function in those women who had sexual intercourse before surgery.

From the *Plastic and Reconstructive Surgery,

Colorectal Oncologic Surgery, and

Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

Received January 30, 2018, and accepted for publication, after revision June 7, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Stefano Bonomi, MD, Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy. E-mail: Stefano.bonomi@istitutotumori.mi.it.

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