The rectus abdominis myocutaneous flap: modifications, complications, and sexual function

Area of Science:

• Reconstructive surgery
• Gynecologic oncology
• Plastic surgery

Background:

• Vaginal, perineal, and pelvic floor reconstruction is increasingly performed with radical pelvic surgery.
• The vertical rectus abdominis myocutaneous flap is well-suited for these reconstructions, but data on its risks are limited.

Purpose of the Study:

• To evaluate the safety and efficacy of the vertical rectus abdominis myocutaneous flap for vaginal/pelvic floor reconstruction.
• To assess patient satisfaction and sexual function outcomes.

Main Methods:

• Chart review of 22 patients undergoing rectus abdominis myocutaneous flap reconstruction between 1990-1997.
• Comparison with existing literature and patient-reported outcomes regarding satisfaction and sexual function.

Main Results:

• 95.5% of reconstructions were performed during pelvic exenteration.
• Graft attachment was successful in 90.9% of patients; 18.2% experienced mild vaginal stenosis.
• Donor site complications included wound separation and delayed closure; no bowel obstruction, hernia, or death occurred.
• Prior abdominal surgery and operative time were risk factors for graft necrosis.
• 59.1% of patients were cancer-free, with 84.6% reporting successful sexual function post-surgery.

Conclusions:

• The rectus abdominis myocutaneous flap offers safe and effective vaginal reconstruction with acceptable morbidity.
• The flap successfully restored sexual function in the majority of cancer survivors.
• Alternative flap sites should be considered for patients with prior abdominal surgery due to potential blood supply compromise.