O'Connell Christopher, Mirhashemi Ramin, Kassira Noor, Lambrou Nicholas, McDonald W Scott
Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Florida 33136, USA.
Ann Plast Surg. 2005 Nov;55(5):470-3. doi: 10.1097/01.sap.0000181361.11851.53.
Pelvic exenteration may be the only curative option for women with recurrent pelvic malignancies. After total pelvic exenteration, the resultant perineal defect heals slowly if left to do so by secondary intention. Reconstruction with the vertical rectus abdominis musculocutaneous (VRAM) flap brings a generous bulk of healthy tissue into the defect, speeding recovery by facilitating primary healing.
Six women underwent reconstruction of a neovagina using a vertical rectus abdominis musculocutaneous flap. All 6 had total pelvic exenteration for advanced gynecologic malignancy. Primary diagnosis was cervical carcinoma (n = 3), vulvar carcinoma (n = 1), nonsmall cell vaginal cancer (n = 1), and vaginal melanoma (n = 1). Four patients had received adjuvant radiotherapy preoperatively.
All flaps remained 100% viable postoperatively. There were no cases of fistula, infection, or bowel obstruction. Two patients died of cardiovascular arrest postoperatively. The 4 other patients report satisfaction with reconstruction. Three had vaginal intercourse with orgasm.
The inferiorly based vertical rectus abdominis musculocutaneous flap is a dependable source of tissue for pelvic reconstruction and is the flap of choice in the Division of Plastic Surgery. In addition to facilitating healing, the VRAM flap (neovagina) improves a woman's psychosocial well-being.
盆腔脏器清除术可能是复发性盆腔恶性肿瘤女性的唯一治愈选择。全盆腔脏器清除术后，如果任由会阴部缺损通过二期愈合自行愈合，愈合过程会很缓慢。采用腹直肌肌皮瓣进行重建可将大量健康组织带入缺损处，通过促进一期愈合加速恢复。
6名女性采用腹直肌肌皮瓣重建阴道。所有6例均因晚期妇科恶性肿瘤接受了全盆腔脏器清除术。原发诊断为宫颈癌（3例）、外阴癌（1例）、非小细胞阴道癌（1例）和阴道黑色素瘤（1例）。4例患者术前接受了辅助放疗。
所有皮瓣术后均100%存活。无瘘管、感染或肠梗阻病例。2例患者术后死于心搏骤停。其他4例患者对重建效果表示满意。3例有性交并达到性高潮。
以下方为蒂的腹直肌肌皮瓣是盆腔重建可靠的组织来源，是整形外科首选的皮瓣。除了促进愈合外，腹直肌肌皮瓣（新阴道）还能改善女性的心理社会幸福感。
