Rectus abdominis myocutaneous flap for primary vaginal reconstruction

Area of Science:

• Gynecologic oncology
• Reconstructive surgery
• Pelvic surgery

Background:

• Reconstructive procedures are increasingly common after radical gynecologic surgeries like pelvic exenteration.
• The gracilis myocutaneous flap, historically used for vaginal reconstruction, has limitations including necrosis and donor site scarring.
• Neovaginal reconstruction with distally based rectus abdominis myocutaneous flaps presents a promising alternative.

Purpose of the Study:

• To evaluate the versatility and reliability of the distally based rectus abdominis myocutaneous flap for neovaginal reconstruction.
• To present a pilot series of patients undergoing this reconstructive technique.
• To describe the operative techniques and advantages of using rectus flaps in pelvic reconstruction.

Main Methods:

• A pilot series of seven patients underwent neovaginal reconstruction using distally based rectus abdominis myocutaneous flaps.
• Flaps were mobilized from the supraumbilical area and incorporated into the primary incision.
• The technique was primarily used in conjunction with pelvic exenteration.

Main Results:

• All flaps demonstrated 100% viability over a 2-year follow-up period.
• No postoperative flap or incisional infections were reported.
• One instance of infraumbilical fascial dehiscence occurred.

Conclusions:

• The distally based rectus abdominis myocutaneous flap is a versatile and reliable option for vaginal reconstruction, particularly after pelvic exenteration.
• This technique offers advantages in terms of flap viability and donor site morbidity compared to historical methods.
• Primary pelvic reconstruction with rectus flaps can be effectively achieved with favorable outcomes.