de Ranieri J, Souloy J
Centre François Baclesse, Caen, France.
Chirurgie. 1999 Feb;124(1):45-50; discussion 50-1. doi: 10.1016/s0001-4001(99)80041-5.
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.
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.
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.
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.
本研究旨在报告一种在全盆腔脏器清扫术和广泛会阴切除术后，使用背阔肌肌皮游离皮瓣进行盆腔填充和会阴重建的新技术。
该技术应用于3例患者，2例男性和1例女性（平均年龄：53.3岁），他们分别因复发性膀胱癌和/或前列腺癌（1例）、复发性直肠癌（1例）以及晚期外阴癌（1例）接受了全盆腔脏器清扫术。在这位需要扩大会阴切除范围的女性患者中，有必要使用双侧皮瓣，但单侧皮瓣通常就足够了。通过手工显微吻合术将皮瓣血管与斯卡帕三角区的股血管相连。
除1例患者出现与该技术无关的出血外，术后过程顺利。1例患者在术后13个月死于败血症并发症，另外2例患者分别在术后6个月和7个月时仍存活。
在进行大范围会阴切除的全盆腔脏器清扫术后，使用背阔肌肌皮游离皮瓣是填充盆腔和恢复会阴皮肤的一种合适方法。需要更多经验来证实这些初步尝试。
