Perineal and Vaginal Reconstruction after Posterior Exenteration with Resection of Distal Vagina and Perineal Body：Cases Report and Literatures Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Ziqiang , ZHANG Yuanchuan , DENG Xiangbing , WANG Mojin , MENG Wenjian , WEI Mingtian , JIN Chengwu

Gastrointestinal and Colorectal Surgery Center， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

WANG Ziqiang, Email: wangzqzyh@163.com

Keywords：

Rectal cancer; Posterior exenteration; Reconstructive surgical procedure; Postoperative complications

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures.
Method 　The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized.
Results 　There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively.
Conclusions 　Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.

Citation： WANG Ziqiang,ZHANG Yuanchuan,DENG Xiangbing,WANG Mojin,MENG Wenjian,WEI Mingtian,JIN Chengwu,.. Perineal and Vaginal Reconstruction after Posterior Exenteration with Resection of Distal Vagina and Perineal Body：Cases Report and Literatures Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1228-1233. doi: Copy

1.	Bullard KM， Trudel JL， Baxter NN， et al. Primary perineal woundclosure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure[J]. Dis Colon Rectum， 2005， 48(3)：438-443.
2.	傅红，黄恺，史向军. 直肠癌腹会阴联合根治术后会阴切口临床处理进展[J]. 世界华人消化杂志， 2008， 16(1)：1-4.
3.	Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy[J]. Cancer， 1948， 1(2)：177-183.
4.	Yang TX， Morris DL， Chua TC. Pelvic exenteration for rectal cancer：a systematic review[J]. Dis Colon Rectum， 2013， 56(4)：519-531.
5.	Veazey PR， McBride CM. Pelvic recurrence of cancer after abdominoperineal resection of the rectum[J]. South Med J， 1979， 72(12)：1545-1547.
6.	Russ JE， Smoron GL， Gagnon JD. Omental transposition flap in colorectal carcinoma：adjunctive use in prevention and treatment of radiation complications[J]. Int J Radiat Oncol Biol Phys， 1984， 10(1)：55-62.
7.	Hultman CS， Sherrill MA， Halvorson EG， et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy：patient selection， technical caveats， and clinical outcomes[J]. Ann Plast Surg， 2010， 64(5)：559-562.
8.	匡毅，李福沛，蒋又新，等. 后盆脏器切除带蒂乙状结肠阴道修复术治疗女性直肠癌[J]. 中国肿瘤临床， 2012， 39(22)：1853-1855.
9.	袁石初，陆家齐，焦华波. 直肠癌盆腔清扫术后带蒂回肠段修复阴道[J]. 中国修复重建外科杂志， 1999， 13(2)：86-87.
10.	Lieberman RC， Feldman S. Primary closure of the perineal woundwith closed continuous transabdominal pelvic irrigation after rectalexcision[J]. Dis Colon Rectum， 1984， 27(8)：526-528.
11.	Buchel EW， Finical S， Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps[J]. Ann Plast Surg， 2004， 52(1)：22-26.
12.	Chessin DB， Hartley J， Cohen AM， et al. Rectus flap reconstr-uction decreases perineal wound complications after pelvic chemo-radiation and surgery：a cohort study[J]. Ann Surg Oncol， 2005，.
13.	(2)：104-110.
14.	Foster JD， Pathak S， Smart NJ， et al. Reconstruction of the peri-neum following extralevator abdominoperineal excision for carcinoma of the lower rectum：a systematic review[J]. Colorectal Dis， 2012， 14(9)：1052-1059.
15.	McCraw JB， Massey FM， Shanklin KD， et al. Vaginal reconstr-uction with gracilis myocutaneous flaps[J]. Plast Reconstr Surg，.
16.	Shibata D， Hyland W， Busse P， et al. Immediate reconstructionof the perineal wound with gracilis muscle flaps following abdom-inoperineal resection and intraoperative radiation therapy for recu-rrent carcinoma of the rectum[J]. Ann Surg Oncol， 1999， 6(1)：33-37.
17.	王波，王志国，连海云，等. 腰臀筋膜皮瓣修复骶部褥疮的临床应用[J]. 实用骨科杂志， 2003， 9(6)：550.
18.	Christensen HK， Nerstrøm P， Tei T， et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer[J]. Dis Colon Rectum， 2011， 54(6)：711-717.
19.	朱丽莉，卜丽文. 股薄肌皮瓣修复直肠癌腹会阴切除术后会阴缺损的护理[J]. 上海护理， 2005， 5(6)：1-3.
20.	Han JG， Wang ZJ， Gao ZG， et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection[J]. Dis Colon Rectum， 2010， 53(2)：219-223.
21.	， 58(2)：176-183.

1. Bullard KM， Trudel JL， Baxter NN， et al. Primary perineal woundclosure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure[J]. Dis Colon Rectum， 2005， 48(3)：438-443.
2. 傅红，黄恺，史向军. 直肠癌腹会阴联合根治术后会阴切口临床处理进展[J]. 世界华人消化杂志， 2008， 16(1)：1-4.
3. Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma. A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy[J]. Cancer， 1948， 1(2)：177-183.
4. Yang TX， Morris DL， Chua TC. Pelvic exenteration for rectal cancer：a systematic review[J]. Dis Colon Rectum， 2013， 56(4)：519-531.
5. Veazey PR， McBride CM. Pelvic recurrence of cancer after abdominoperineal resection of the rectum[J]. South Med J， 1979， 72(12)：1545-1547.
6. Russ JE， Smoron GL， Gagnon JD. Omental transposition flap in colorectal carcinoma：adjunctive use in prevention and treatment of radiation complications[J]. Int J Radiat Oncol Biol Phys， 1984， 10(1)：55-62.
7. Hultman CS， Sherrill MA， Halvorson EG， et al. Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy：patient selection， technical caveats， and clinical outcomes[J]. Ann Plast Surg， 2010， 64(5)：559-562.
8. 匡毅，李福沛，蒋又新，等. 后盆脏器切除带蒂乙状结肠阴道修复术治疗女性直肠癌[J]. 中国肿瘤临床， 2012， 39(22)：1853-1855.
9. 袁石初，陆家齐，焦华波. 直肠癌盆腔清扫术后带蒂回肠段修复阴道[J]. 中国修复重建外科杂志， 1999， 13(2)：86-87.
10. Lieberman RC， Feldman S. Primary closure of the perineal woundwith closed continuous transabdominal pelvic irrigation after rectalexcision[J]. Dis Colon Rectum， 1984， 27(8)：526-528.
11. Buchel EW， Finical S， Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps[J]. Ann Plast Surg， 2004， 52(1)：22-26.
12. Chessin DB， Hartley J， Cohen AM， et al. Rectus flap reconstr-uction decreases perineal wound complications after pelvic chemo-radiation and surgery：a cohort study[J]. Ann Surg Oncol， 2005，.
13. (2)：104-110.
14. Foster JD， Pathak S， Smart NJ， et al. Reconstruction of the peri-neum following extralevator abdominoperineal excision for carcinoma of the lower rectum：a systematic review[J]. Colorectal Dis， 2012， 14(9)：1052-1059.
15. McCraw JB， Massey FM， Shanklin KD， et al. Vaginal reconstr-uction with gracilis myocutaneous flaps[J]. Plast Reconstr Surg，.
16. Shibata D， Hyland W， Busse P， et al. Immediate reconstructionof the perineal wound with gracilis muscle flaps following abdom-inoperineal resection and intraoperative radiation therapy for recu-rrent carcinoma of the rectum[J]. Ann Surg Oncol， 1999， 6(1)：33-37.
17. 王波，王志国，连海云，等. 腰臀筋膜皮瓣修复骶部褥疮的临床应用[J]. 实用骨科杂志， 2003， 9(6)：550.
18. Christensen HK， Nerstrøm P， Tei T， et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer[J]. Dis Colon Rectum， 2011， 54(6)：711-717.
19. 朱丽莉，卜丽文. 股薄肌皮瓣修复直肠癌腹会阴切除术后会阴缺损的护理[J]. 上海护理， 2005， 5(6)：1-3.
20. Han JG， Wang ZJ， Gao ZG， et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection[J]. Dis Colon Rectum， 2010， 53(2)：219-223.
21. ， 58(2)：176-183.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Perineal and Vaginal Reconstruction after Posterior Exenteration with Resection of Distal Vagina and Perineal Body：Cases Report and Literatures Review

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