Wong Sarah, Garvey Patrick, Skibber John, Yu Peirong
Houston, Texas From the Department of Plastic Surgery and the Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2009 Oct;124(4):1177-1185. doi: 10.1097/PRS.0b013e3181b5a40f.
The rectus abdominis may be unavailable or insufficient to reconstruct large pelvic exenteration defects. The purpose of this study was to report the authors' experience with the pedicled anterolateral thigh-vastus lateralis muscle flap for such reconstructions.
Eighteen patients with pelvic exenteration underwent reconstruction with this flap between 2003 and 2007. When the perineal defect could be closed primarily, the vastus lateralis muscle was tunneled over the inguinal ligament into the pelvis (inguinal route). For concomitant perineal-vaginal reconstruction, the anterolateral thigh-vastus lateralis muscle was tunneled over the medial thigh to the defect (perineal route).
All 18 patients (five men and 13 women) received preoperative chemoradiation. Nine patients received intraoperative pelvic brachytherapy. After pelvic exenteration, a colostomy was created in all patients, and a urostomy with ileal conduit was created in eight patients. The inguinal route was used in six patients and the perineal route was used in 10 patients. In the remaining two patients, the anterolateral thigh-vastus lateralis muscle from one thigh was delivered through the perineal route and the contralateral vastus lateralis flap was delivered through the inguinal route. Postoperative complications included five small perineal wound dehiscences that healed spontaneously, one flap failure caused by pedicle tension in an obese patient with a short thigh, an enterocutaneous fistula, and an ileal conduit leak that healed spontaneously. No hernias occurred.
The pedicled anterolateral thigh-vastus lateralis flap is a good alternative for reconstruction of large pelvic exenteration defects when the rectus abdominis flap is unavailable. Obese patients with short thighs may not be good candidates for this procedure.
腹直肌可能无法获取或不足以修复大型盆腔脏器清除术后的缺损。本研究的目的是报告作者使用带蒂股前外侧 - 股外侧肌皮瓣进行此类修复的经验。
2003年至2007年间，18例盆腔脏器清除术患者接受了该皮瓣修复。当会阴缺损可一期闭合时，股外侧肌经腹股沟韧带隧道进入骨盆（腹股沟入路）。对于同时进行会阴 - 阴道修复，股前外侧 - 股外侧肌经大腿内侧隧道至缺损处（会阴入路）。
所有18例患者（5例男性和13例女性）均接受了术前放化疗。9例患者接受了术中盆腔近距离放疗。盆腔脏器清除术后，所有患者均行结肠造口术，8例患者行回肠导管造口术。6例患者采用腹股沟入路，10例患者采用会阴入路。其余2例患者中，一侧大腿的股前外侧 - 股外侧肌经会阴入路转移，对侧股外侧肌皮瓣经腹股沟入路转移。术后并发症包括5例小的会阴伤口裂开，均自行愈合；1例肥胖且大腿短的患者因蒂部张力导致皮瓣坏死；1例肠造口皮肤瘘；1例回肠导管漏，自行愈合。无疝发生。
当腹直肌皮瓣无法使用时，带蒂股前外侧 - 股外侧肌皮瓣是修复大型盆腔脏器清除术后缺损的良好替代方案。大腿短的肥胖患者可能不是该手术的合适人选。
