Stern J L, Lacey C G
Baillieres Clin Obstet Gynaecol. 1987 Jun;1(2):277-92. doi: 10.1016/s0950-3552(87)80055-x.
An important aspect of the care of women with a gynaecological malignancy is not only improved survival, but complete rehabilitation. There are a number of reconstructive techniques available which can be used at the time of radical surgery, or at some later date, to correct the untoward effects of therapy. Whenever possible, the least morbid, yet most reliable reconstructive procedure should be performed at the initial surgery to decrease postoperative morbidity and wound infection and improve rehabilitation and body image. For many situations there is no single ideal procedure, therefore one should be familiar with several techniques in order to select or adapt the procedure best suited to the circumstances. The split thickness skin graft (STSG) is used primarily to cover skin defects where there has been little or no loss of subcutaneous tissue, such as after skinning vulvectomy for carcinoma in situ. It is also the procedure of choice for vaginal reconstruction after simple vaginectomy for extensive in situ carcinoma and for congenital absence of the vagina. It may also be useful in the management of vaginal distortion, secondary to previous surgery or radiation therapy. In gynaecology, full thickness skin flaps are used when there has been major loss of skin and subcutaneous tissue of the vulva, groin or vagina. Defined arterial and fasciocutaneous flaps are more reliable than random cutaneous flaps, but they are not mutually exclusive in their application. Thus, one or the other may be used for the same defect in differing patients, depending on the situation. Circumstances that dictate which flap is preferable include size, contour, depth of the deformity, proximity of the deformity to the potential donor site, presence of necrosis and infection, and the requirement for new blood supply, as in an irradiated wound. In appropriately selected patients the myocutaneous flap will provide the most reliable source of a new blood supply. If the requirement for a new blood supply is of paramount importance, and the myocutaneous flap is too thick, the skin and subcutaneous tissue may be sacrificed to reduce the size of the flap. A STSG can then be applied at a later time to achieve the desired result. There are many other situations when several reconstructive procedures used simultaneously, or serially, may be required to achieve a balance between anatomy and function. However, ultimate success will depend largely on patient selection, familiarity with the procedures, and exacting surgical technique.
对患有妇科恶性肿瘤的女性进行护理，一个重要方面不仅是提高生存率，还要实现完全康复。有多种重建技术可供使用，可在根治性手术时或之后的某个时间用于纠正治疗的不良影响。只要有可能，应在初次手术时进行创伤最小但最可靠的重建手术，以降低术后发病率和伤口感染率，并改善康复情况和身体形象。对于许多情况，没有单一的理想手术方法，因此，为了选择或调整最适合具体情况的手术方法，应该熟悉多种技术。断层皮片移植（STSG）主要用于覆盖皮下组织很少或没有损失的皮肤缺损，如原位癌行外阴去皮切除术后。对于广泛原位癌行单纯阴道切除术后以及先天性阴道缺失的阴道重建，它也是首选方法。它也可能有助于处理既往手术或放射治疗引起的阴道变形。在妇科领域，当外阴、腹股沟或阴道的皮肤和皮下组织大量缺失时，会使用全厚皮瓣。明确的动脉皮瓣和筋膜皮瓣比随意皮瓣更可靠，但在应用中它们并非相互排斥。因此，根据具体情况，对于不同患者的相同缺损，可使用其中一种或另一种皮瓣。决定哪种皮瓣更合适的情况包括缺损的大小、外形、畸形深度、畸形与潜在供区的距离、坏死和感染的存在情况，以及对新血供的需求，如在放疗后的伤口。在适当选择的患者中，肌皮瓣将提供最可靠的新血供来源。如果对新血供的需求至关重要，而肌皮瓣太厚，则可牺牲皮肤和皮下组织以减小皮瓣大小。然后可在稍后应用断层皮片移植以达到预期效果。在许多其他情况下，可能需要同时或相继使用多种重建手术，以在解剖结构和功能之间取得平衡。然而，最终的成功很大程度上取决于患者的选择、对手术方法的熟悉程度以及精湛的手术技巧。
