The use of tissue flaps as an adjunct to pelvic surgery.
BACKGROUND
The clinical problems of advanced malignancy with invasion of cancers into adjacent organs or structures, fistulizing complications from radiation therapy, postoperative infections, and delayed postoperative healing continue to challenge pelvic surgeons, regardless of subspecialty. The use of autologous muscle and myocutaneous flaps has been applied to the management and prevention of these clinical problems and found to be most helpful.


METHODS
Records of patients undergoing abdominopelvic procedures in a single unit during the 15-year period from 1990 to 2005 were reviewed, and patients undergoing autologous tissue flaps were reviewed with respect to indications, complications, and outcomes.


RESULTS
Thirty-four patients underwent 35 autologous muscle or myocutaneous flaps for the following indications: large anticipated defects in primary or reoperative cancer surgery (13 patients); malignant, traumatic, inflammatory, or radiation-induced fistulae (12 patients); excision of (an) adjacent organ(s) with need for reconstruction (7 patients); and chronic nonhealing pelvic wounds (2 patients). Wound complications occurred in 41% of patients; however, primary healing of flaps occurred in 88% of patients.


CONCLUSIONS
The use of autologous tissue flaps in select patients can be a useful adjunct in pelvic surgery in dealing with a wide variety of problems, specifically in filling large defects, providing vascularized tissue for fistula closure, and avoiding delayed wound healing commonly seen after high-dose radiation.
Galandiuk
Susan
S
Department of Surgery, Section of Colon and Rectal Surgery, University of Louisville School of Medicine, and Digestive Health Center, University of Louisville Hospital, Louisville, KY 40292, USA. s0gala01@gwise.louisville.edu
Jorden
Jeffrey
J
Mahid
Suhal
S
McCafferty
Michael H
MH
Tobin
Gordon
G
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007813:Laparotomy / Q000379:methods; D010385:Pelvic Exenteration / Q000009:adverse effects; D010388:Pelvis / Q000503:physiopathology / Q000601:surgery; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology