Vaginal reconstruction following extensive treatment for pelvic cancer.

Since 1970, 23 patients at UCLA and The City of Hope who have undergone extensive treatment for pelvic malignancy have had vaginal function successfully restored. A combination of methods, including split-thickness skin graft and the construction of an external vulvar pouch, is often necessary to obtain maximal functional results. The external vulvar pouch was very useful, although not as anatomically appealing as internal methods of reconstruction. In young patients who required an exenteration, a new technique using part of the anterior bladder fundus was developed. Preliminary experience with this method was promising. Among the gorup of 23 patients, there have been no overt failures. By combining restoration of rectal function with vaginal reconstruction, two major steps have been taken toward total rehabilitation of the patient undergoing extensive treatment for pelvic malignancy. Persistence, ingenuity, and planning by the surgeon are essential to obtain a maximum functional result for each patient.