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Dynamic Article: Vaginal and Perineal Reconstruction Using Rectus Abdominis Myocutaneous Flap in Surgery for Locally Advanced Rectum Carcinoma and Locally Recurrent Rectum Carcinoma

Holman, Fabian A. M.D.1; Martijnse, Ingrid S. M.D.2; Traa, Marjan J. M.Sc.3; Boll, Dorry M.D.4; Nieuwenhuijzen, Grard A. M.D., Ph.D.2; de Hingh, Ignace H. M.D., Ph.D.2; Rutten, Harm J. M.D., Ph.D., F.R.C.S.(Lond)2

doi: 10.1097/DCR.0b013e31827a267c
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: Surgery for locally advanced and recurrent rectal carcinoma sometimes requires partial resection of the perineum and/or vagina necessitating subsequent reconstruction.

OBJECTIVE: The aim of this study was to describe the surgical and functional outcomes of reconstructing the vagina and/or the perineum by using the vertical rectus abdominis myocutaneous flap and to evaluate the health status of patients who received reconstruction.

DESIGN: This is a retrospective cohort study.

SETTINGS: This study was conducted at a tertiary referral hospital for locally advanced and recurrent rectal cancer.

PATIENTS: Patients receiving multimodality treatment for primary or recurrent locally advanced rectal carcinomas were included.

MAIN OUTCOME MEASURES: First, the surgical outcome was assessed. Second, 10 female patients who received vaginal reconstruction underwent a gynecological examination including biopsies. Finally, quality of life was assessed and compared with patients who underwent treatment for rectal carcinoma without a reconstruction.

RESULTS: Fifty-one patients underwent reconstruction of the dorsal vagina and/or the perineum with the use of a vertical rectus abdominis myocutaneous flap. In 13 patients, the flap was used to close a perineal defect; in 26 patients, to close a vaginal defect; and in 12 patients, to close both. In 3 patients, partial necrosis of the flap occurred that was treated conservatively. In 4 patients, stenosis of the introitus occurred, as found in the gynecological examination. Biopsies confirmed epithelialization of the vaginal wall. All groups reported good functioning and low symptom burden. After vaginal reconstruction, women reported equal or higher scores on global health status, emotional functioning, and body image.

LIMITATIONS: The lack of information on the health status of the patients before the start of treatment prohibits making causal inferences in health status over time.

DISCUSSION: Reconstruction of the perineum and/or dorsal vagina was successful in all patients. Surgeons and gynecologists who use the vertical rectus abdominis myocutaneous flap should be aware of stenosis of the vaginal introitus. Gynecological consultation at an early stage should be standard.

Supplemental Digital Content is available in the text.

1 Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands

2 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

3 CoRPS – Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands

4 Department of Gynaecology, Tweesteden Hospital, Tilburg, The Netherlands

Financial Disclosure: None reported.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Correspondence: H. J. Rutten, M.D., Ph.D., F.R.C.S., Department of Surgery Catharina Hospital, The Netherlands, PO Box 1350 5602 ZA, Eindhoven, The Netherlands. E-mail:

© The ASCRS 2013