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401 Primary flap closure of perineal defects after pelvic exenteration in gynecologic malignancies: an overview of a debated topic
  1. Stefano Restaino1,
  2. Martina Arcieri1,2,
  3. Giulia Pellecchia3,
  4. Andrea Rosati4,
  5. Roberta Granese5,
  6. Canio Martinelli6,
  7. Anna Amelia Caretto7,
  8. Stefano Cianci8,
  9. Pier Camillo Parodi9,
  10. Lorenza Driul1,3,
  11. Stefano Gentileschi10,11,
  12. Giovanni Scambia12,
  13. Alfredo Ercoli13 and
  14. Giuseppe Vizzielli1,3
  1. 1Department of Maternal and Child Health, ‘Santa Maria della Misericordia’ University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
  2. 2Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
  3. 3Medical Area Department (DAME), University of Udine, Udine, Italy
  4. 4Gynecologic Oncology, Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Gynecology and Obstetrics, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5Unit of Gynecology and Obstetric, Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University Hospital, Messina, Italy
  6. 6Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ``G. Baresi’’, University Hospital ``G. Martino’’, Messina, Italy, Messina, Italy
  7. 7Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Rome, Italy
  8. 8Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood, Messina, Italy
  9. 9Plastic and Reconstructive Surgery, Department of Medical Area (DAME), University Hospital of Udine, Udine, Italy
  10. 10Department of Translational Medicine and Surgery, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
  11. 11Department of Plastic Surgery, Department of Women’s, Children’s and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Rome, Italy
  12. 12Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  13. 13Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood ’G. Baresi’, University Hospital ’G. Martino’, Messina, Italy


Introduction/Background Pelvic exenteration (PE) is a surgical procedure performed as salvage treatment in patients with recurrent or persistent gynaecological cancers. Radical alteration of pelvis and pelvic floor anatomy cause often major complications. Fortunately, PE can be combined with reconstructive techniques to decrease complications and reduce postoperative morbility and mortality. Many options for reconstructive surgery have been described, especially a wide spectrum of surgical flaps. Various criteria have been suggested for the selection of patients undergoing primary closure of perineal defect flaps; however, none have conclusively identified the optimal choice.

Methodology The aim of our study was to focus on technical aspects and the advantages and disadvantages of reconstructive technique, providing an overview of those most frequently used for the treatment of pelvic floor defects after PE.

Results Flaps based on the deep inferior epigastric artery, especially vertical rectus abdominis musculocutaneous (VRAM) flaps, and gracilis muscle flaps, are the most common reconstructive techniques used for pelvic floor and vaginal reconstruction (figure 1). The first type of flap has the advantage of providing a large amount of tissue to reconstruct the perineum or vagina but has the disadvantage of interfering with the integrity of the abdominal wall. Gracilis flaps do not create abdominal wall defects but the lack of perforators, which causes poor perfusion reliability of the skin pad, small muscle volume and limited excursion are its most important limitations.

Conclusion In our opinion, reconstructive surgery may be considered in case of total or type II/III PE and in patients submitted to prior pelvic irradiation. VRAM could be used to close extended defects at the time of PE, while gracilis flaps can be used in case of VRAM complications (figure 2). As these techniques will continue to evolve, it is recommended to adopt an integrated, multidisciplinary approach within a tertiary medical center.

Disclosures Authors declare to have no disclosures.

Abstract 401 Figure 1

Surgical flaps

Abstract 401 Figure 2

Proposed surgical algorithm for reconstructive flap after type II/III PE previously irradiated

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