Vulva reconstruction after pelvic exenteration, using a unique combination of two flaps

Area of Science:

• Surgical Oncology
• Reconstructive Surgery
• Gynecologic Oncology

Background:

• Recurrent vulvar cancer in irradiated areas presents significant reconstructive challenges.
• Total pelvic exenteration is a radical surgical option for advanced or recurrent pelvic malignancies.
• Large pelvic defects often require well-vascularized tissue for successful reconstruction.

Observation:

• A 64-year-old woman with recurrent vulvar carcinoma underwent en-bloc total pelvic exenteration.
• Pelvic defect reconstruction utilized a combined anterolateral thigh (ALT) flap and a rectus abdominis muscle (RAM) flap (PM/RAM).
• This specific combination of flaps was employed for a large, previously irradiated pelvic defect.

Findings:

• The combined ALT and PM/RAM flap technique provided a unique and effective solution for extensive pelvic reconstruction.
• This dual-flap approach leveraged the reliable vascularity of the PM/RAM flap with the bulk of the ALT flap.
• Excellent reconstructive results were achieved using this innovative flap combination.

Implications:

• This combined flap strategy offers a viable option for complex pelvic defect reconstruction in challenging oncologic cases.
• The synergistic use of ALT and PM/RAM flaps may improve outcomes in patients requiring extensive pelvic resections.
• Further research into optimizing multi-flap combinations for pelvic reconstruction is warranted.