Sood Anil K, Cooper Brian C, Sorosky Joel I, Ramirez Pedro T, Levenback Charles
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Obstet Gynecol. 2005 Mar;105(3):514-8. doi: 10.1097/01.AOG.0000154158.41973.a2.
We describe a modification of the traditional vertical rectus abdominis myocutaneous flap for neovagina creation and our experience to date.
Our modified vertical rectus abdominis myocutaneous flap uses a smaller flap size with a full-thickness skin graft posteriorly to decrease the size of the abdominal wall defect. We have used the modified vertical rectus abdominis myocutaneous flap in 18 patients between March 1998 and March 2004 to create a neovagina after exenterative surgery.
The mean age of the patients was 54 years, and the mean body mass index was 27 (range 18-44). Twelve patients underwent a total pelvic, 5 anterior, and 1 posterior exenteration. Among the 13 patients requiring a colostomy, the vertical rectus abdominis myocutaneous flap was taken from the contralateral side. In these patients, the urostomy was brought out on the vertical rectus abdominis myocutaneous flap donor side. There has been only 1 partial flap loss, which eventually resulted in a fully epithelialized neovagina. Eight patients at last follow-up were sexually active. Two other patients have died from recurrent disease, and 2 are alive with recurrence. The other 6 patients have no evidence of recurrent disease and, although not sexually active at the time of this report, have a viable and adequate neovagina. All patients had a successful primary closure of the abdominal wound in a vertical fashion. Three patients had superficial abdominal wound breakdown, which healed by secondary intention.
The modified vertical rectus abdominis myocutaneous flap allows for creation of an adequate neovagina with a smaller abdominal wall defect.
我们描述了一种用于创建新阴道的传统垂直腹直肌肌皮瓣的改良方法以及我们迄今为止的经验。
我们改良的垂直腹直肌肌皮瓣采用较小的皮瓣尺寸，并在后方进行全厚皮片移植，以减小腹壁缺损的大小。1998年3月至2004年3月期间，我们使用改良的垂直腹直肌肌皮瓣为18例患者在广泛性手术切除后创建新阴道。
患者的平均年龄为54岁，平均体重指数为27（范围18 - 44）。12例患者接受了全盆腔清扫术，5例接受了前盆腔清扫术，1例接受了后盆腔清扫术。在13例需要结肠造口术的患者中，垂直腹直肌肌皮瓣取自对侧。在这些患者中，尿路造口在垂直腹直肌肌皮瓣供皮侧引出。仅发生1例部分皮瓣丢失，最终形成了完全上皮化的新阴道。最后一次随访时，8例患者有性生活。另外2例患者死于疾病复发，2例患者带瘤生存。其他6例患者无疾病复发证据，尽管在本报告时没有性生活，但有一个存活且合适的新阴道。所有患者的腹部伤口均以垂直方式成功一期缝合。3例患者出现腹部伤口浅表裂开，经二期愈合。
改良的垂直腹直肌肌皮瓣能够在较小的腹壁缺损情况下创建合适的新阴道。
