Vaginal reconstruction following resection of primary locally advanced and recurrent colorectal malignancies.
OBJECTIVE
Vertical rectus abdominus myocutaneous flap reconstruction facilitates healing within the radiated pelvis and preserves the possibility of subsequent sexual function in patients with colorectal cancer who require partial or complete resection of the vagina.


METHODS
A retrospective review of a consecutive series of patients.


METHODS
A tertiary referral center.


METHODS
All patients undergoing surgical treatment of locally advanced or recurrent colorectal cancer and vertical rectus abdominus myocutaneous flap reconstruction of the vagina.


METHODS
Vertical rectus abdominus myocutaneous flap reconstruction.


METHODS
Operative feasibility, complications, and sexual function.


RESULTS
Twelve patients underwent extended resection for primary locally advanced or recurrent colorectal cancer including total or near total vaginectomy. Median age was 47 years. Tumors included 9 rectal adenocarcinomas, 2 anal squamous cell carcinomas, and 1 recurrent cecal adenocarcinoma. Surgical procedures included 8 abdominoperineal resections with posterior exenteration; resection of pelvic tumor and partial vaginectomy in 2 patients with previous abdominoperineal resection; 1 total exenteration; and 1 total proctocolectomy with posterior exenteration. The average operative time for tumor extirpation, irradiation, and reconstruction was more than 9 hours and all patients required blood transfusions. Despite 2 patients having superficial necrosis and 4 having mild wound infections, no patient required reoperation and all achieved complete healing. Five patients reported resuming sexual intercourse.


CONCLUSIONS
The vertical rectus abdominus myocutaneous flap can be successfully used for vaginal reconstruction following resection of locally advanced colorectal cancer. It provides nonirradiated, vascularized tissue that fills the pelvic dead space, allows for stomal placement, and provides a chance for sexual function.
D'Souza
Dougal N
DN
Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Pera
Miguel
M
Nelson
Heidi
H
Finical
Stephan J
SJ
Tran
Nho V
NV
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*