Reconstruction of pelvic exenteration defects with anterolateral thigh-vastus lateralis muscle flaps

The rectus abdominis may be unavailable or insufficient to reconstruct large pelvic exenteration defects. The purpose of this study was to report the authors' experience with the pedicled anterolateral thigh-vastus lateralis muscle flap for such reconstructions.

Eighteen patients with pelvic exenteration underwent reconstruction with this flap between 2003 and 2007. When the perineal defect could be closed primarily, the vastus lateralis muscle was tunneled over the inguinal ligament into the pelvis (inguinal route). For concomitant perineal-vaginal reconstruction, the anterolateral thigh-vastus lateralis muscle was tunneled over the medial thigh to the defect (perineal route).

All 18 patients (five men and 13 women) received preoperative chemoradiation. Nine patients received intraoperative pelvic brachytherapy. After pelvic exenteration, a colostomy was created in all patients, and a urostomy with ileal conduit was created in eight patients. The inguinal route was used in six patients and the perineal route was used in 10 patients. In the remaining two patients, the anterolateral thigh-vastus lateralis muscle from one thigh was delivered through the perineal route and the contralateral vastus lateralis flap was delivered through the inguinal route. Postoperative complications included five small perineal wound dehiscences that healed spontaneously, one flap failure caused by pedicle tension in an obese patient with a short thigh, an enterocutaneous fistula, and an ileal conduit leak that healed spontaneously. No hernias occurred.

The pedicled anterolateral thigh-vastus lateralis flap is a good alternative for reconstruction of large pelvic exenteration defects when the rectus abdominis flap is unavailable. Obese patients with short thighs may not be good candidates for this procedure.