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Abstract
Objectives Cervical cancer is common in younger women, with risks of surgery for advanced disease including altered body image and psychosexual dysfunction. This specialist technique highlights multidisciplinary management whilst minimising complications.
Methods A 42-year-old female with a stage 1B2 lymph node positive cervical adenocarcinoma managed with primary chemoradiotherapy underwent total pelvic infralevator exenteration for recurrence; with vulval sparing and VRAM reconstruction of the pelvic floor, perineum and neovagina formation.
Results Following preoperative marking and perforating vessel Doppler identification of the anterior abdominal wall; the anterior rectus sheath was preserved to the medial row and exenteration procedure completed with staggered urostomy and ileostomy. The VRAM (including skin, subcutaneous tissue, sheath and muscle) was then completed along the lateral aspect with preservation of the rectus abdominus insertion pedicle including inferior epigastric artery. The flap was rotated to the perineum with tubing of the neovagina and de-epithelization for pelvic floor reconstruction. The abdomen was closed with a vicryl mesh insert.
Conclusions VRAM flap provides a reliable blood supply and viable tissue from a non-irradiated site with acceptable scarring. This reduces issues with empty pelvic syndrome and allows for ligation of the internal iliac artery. The patient made an uneventful recovery with retained sensation of the remaining vulva and flap. She continues under surveillance and vaginal mechanical dilation regime. We emphasise preservation of appearance and function in achieving patient satisfaction.