Vaginal reconstruction performed simultaneously with pelvic exenteration.

Twenty-eight patients underwent vaginal reconstruction simultaneously with pelvic exenteration performed for recurrent pelvic malignancy. A satisfactory neovagina was created in 24 (86%) patients. Successful bilateral grafting was accomplished in 18 of 21 (86%) patients using gracilis myocutaneous grafts. Seven patients had a split-thickness skin graft, most of which was combined with an omental pedicle graft; six of these patients had a satisfactory neovagina. None of the patients developed herniation of the bowel through the reconstructed pelvic floor, or fistulas in the absence of recurrent malignancy. The gracilis myocutaneous graft is most feasible in patients in whom total pelvic exenteration is performed, whereas a split-thickness graft is preferable in those patients who undergo anterior exenteration or who have rectosigmoid reconstruction using low colon reanastomosis.