[Pelvic filling and perineal reconstruction using longissimus dorsalis myocutaneous flap after total pelvic exenteration].

AIM

The study aim was to report an original technique for pelvic cavity filling and perineal floor reconstruction with longissimus dorsalis myocutaneous free flap after total pelvic exenteration and extensive perineumectomy.

PATIENTS AND METHOD

This technique was used in three patients, two men and one women (mean age: 53.3 years) after total pelvic exenteration for recurrent carcinoma of the bladder and/or prostate (n = 1), recurrent rectal carcinoma (n = 1) and extended vulvar carcinoma (n = 1). In this female patient, who required an extended perineal resection, it was necessary to use a bilateral flap, but a unilateral flap is usually sufficient. The vessels of the flap were connected with the femoral vessels in the Scarpa's triangle by a manual microanastomosis.

RESULTS

The postoperative course was uneventful except for one patient who had an hemorrhage unrelated to the technique. One patient died after 13 months of septic complications and the two other patients were alive after 6 and 7 months.

CONCLUSION

The use of longissimus dorsalis myocutaneous free flap is a suitable procedure in order to fill the pelvic cavity and restore the perineal skin after a total pelvic exenteration with large perineal resection. Further experience is necessary to confirm these first attempts.