Hui Kenneth, Zhang Feng, Pickus Evan, Rodriguez Luis F, Teng Nelson, Lineaweaver William C
Division of Plastic Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
Ann Plast Surg. 2003 Dec;51(6):556-60. doi: 10.1097/01.sap.0000096444.59573.87.
Radical vulvoperineal ablations present challenging reconstructive dilemmas, especially when local metastatic spread requires distal vaginal and anal resection. Despite advances in vaginal salvage and sphincteroplasty, surface recontouring remains elusive because of the necessity to resurface a large, complex area that includes the mons, vulva, and fourchette. We describe a modification of the inferior-based vertical rectus abdominis musculocutaneous (VRAM) flap where the superior portion is split longitudinally to produce "tongue" flaps, which can resurface complex vulvoperineal wounds. By splitting the flap, one can resurface the vulva, provide an edge to reattach the vaginal cuff, and recreate the fourchette and line the anoderm after anoplasty. This musculocutaneous flap provides adequate contour and protection against radiation injury. Splitting of the flap is based on the vascular territory of the superior epigastric branches and their perforators and can be carried down to the level of their anastomosis, with the inferior system at the level of the umbilicus. The split VRAM flap has been used successfully in 3 patients with complex perineal wounds with excellent results and maintenance of vaginal patency.
根治性外阴会阴切除术带来了具有挑战性的重建难题，尤其是当局部转移扩散需要切除远端阴道和肛门时。尽管在阴道挽救和括约肌成形术方面取得了进展，但由于需要对外阴、小阴唇和会阴体等大面积复杂区域进行表面重塑，表面重塑仍然难以实现。我们描述了一种基于下方的垂直腹直肌肌皮瓣（VRAM）的改良方法，即纵向劈开其上部以产生“舌状”皮瓣，该皮瓣可用于修复复杂的外阴会阴伤口。通过劈开皮瓣，可以对外阴进行表面重塑，为重新连接阴道断端提供边缘，并在肛门成形术后重建会阴体和衬里肛门皮肤。这种肌皮瓣提供了足够的外形并能防止放射性损伤。皮瓣的劈开基于腹壁上动脉分支及其穿支的血管分布区域，并且可以向下延伸至它们与脐水平的下腹部血管系统的吻合处。劈开的VRAM皮瓣已成功应用于3例复杂会阴伤口患者，效果极佳，且维持了阴道通畅。
