Vaginal reconstruction at the time of pelvic exenteration: a surgical and psychosexual analysis of techniques.
OBJECTIVE
Vaginal reconstruction following pelvic exenteration is an important aspect of the physical and psychological rehabilitation of women after radical surgery for pelvic malignancies. The choice of techniques is vast, and proper patient and surgical selection is important for obtaining satisfactory functional and aesthetic results. The objective of this retrospective study is to review different techniques for vaginal reconstruction and report the complications and patient satisfaction associated with the different procedures.


METHODS
Between January 1988 and April 2001, 104 pelvic exenterations were performed by the division of gynecologic oncology at the University of Miami, School of Medicine. Twenty-five (24%) patients underwent vulvo-vaginal reconstruction at the time of the exenteration. A retrospective chart review of the 25 patients was performed, and 9 patients were available and contacted for an interview.


RESULTS
Twenty-four (96%) patients had received prior definitive radiation therapy. Overall, there were 9 complications (6 major and 3 minor) attributed to vaginal reconstruction, accounting for 36% perioperative morbidity. Seven of the nine (78%) patients interviewed reported successful vaginal intercourse at some point after their operation. All 5 surviving patients in the myocutaneous flap group were very satisfied with their sexual function and were sexually active at the time of their interview.


CONCLUSIONS
Vaginal reconstruction at the time of pelvic exenteration is an important topic that should be discussed with the patient during the preoperative visit. Although the myocutaneous flaps are associated with longer operative times, they appear to be the preferred type due to decreased postoperative fistulae and better patient satisfaction.
Mirhashemi
Ramin
R
Division of Gynecologic Oncology, School of Medicine, University of Miami, 1475 NW 12th Avenue, Suite 3500, Miami, FL 33136, USA. Rmirhashemi@med.miami.edu
Averette
Hervy E
HE
Lambrou
Nicholas
N
Penalver
Manuel A
MA
Mendez
Luis
L
Ghurani
Giselle
G
Salom
Emory
E
D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000523:psychology / Q000601:surgery*; D006801:Humans; D017060:Patient Satisfaction; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D010386:Pelvic Neoplasms / Q000523:psychology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000523:psychology; D013524:Surgical Flaps; D014621:Vagina / Q000601:surgery*