Abdou A, Bruns H, Troja A, Antolovic D, Li L, Raab H-R
Universitätsklinik für Allgemein- und Viszeralchirurgie, Med. Campus der C.-v.-Ossietzky-Universität, Klinikum Oldenburg, Deutschland.
Zentralbl Chir. 2015 Apr;140(2):214-8. doi: 10.1055/s-0035-1545809. Epub 2015 Apr 14.
Extended resections of pelvic malignancies, especially in cases of recurrent malignancies, result in the formation of large tissue defects in the region of the pelvic floor and perineum, which are difficult to deal with. Both after extra levator rectal excision and pelvic exenteration, wound healing deficiencies and local infections of the perineal wound are frequent. Primary closure is often impossible due to a lack of tissue substance after resection and an additional previous radiotherapy in most cases. This can result in poor or non-healing wounds, a consecutive need of complex care and an increased risk of secondary problems including tumour recurrences. A permanent wound closure of good quality can therefore only be achieved by plastic surgery. This can be done by local or distant muscle flaps with or without skin, for example, the gluteus maximus flap, the vertical rectus abdominis muscle flap (VRAM) or free flaps such as the latissimus dorsi flap.
盆腔恶性肿瘤的扩大切除术，尤其是复发性恶性肿瘤的情况，会导致盆底和会阴区域形成大的组织缺损，处理起来很困难。在直肠提肌外切除和盆腔脏器清除术后，会阴伤口的愈合缺陷和局部感染都很常见。由于切除后缺乏组织物质，且大多数情况下之前还接受过放疗，一期缝合往往无法进行。这可能导致伤口愈合不良或不愈合，继而需要复杂的护理，并且包括肿瘤复发在内的继发问题风险增加。因此，只有通过整形手术才能实现高质量的永久性伤口闭合。这可以通过带或不带皮肤的局部或远处肌皮瓣来完成，例如臀大肌瓣、腹直肌垂直肌瓣（VRAM）或背阔肌瓣等游离皮瓣。
