title: Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series.
abstract: Vaginal reconstruction after pelvic exenteration (PE) represents a challenge for the oncologic surgeon. Since the introduction of perforator flaps, using pedicled vertical DIEP (deep inferior epigastric perforator) flap allows to reduce the donor site complication rate. From November 2012 to December 2014, 27 PEs were performed in our institution. 13 patients who underwent PE with vaginal reconstruction and programmed DIEP procedure for gynecologic malignancies were registered. Nine patients underwent PE for recurrent disease and four for primary treatment. Six of the 13 patients have a preoperative fistula. Anterior PE was performed in 10 patients, and total PE in 3 patients. A vertical DIEP flap was performed in 10 patients using one or two medial perforators. The reasons for abortion of vertical DIEP flap procedure were: failure to localizing perforator vessels in two cases, and unavailability of plastic surgeon in one case. A vertical fascia-sparring rectus abdominis myocutaneous flap was then harvested. Median length of surgery was 335min, and 60min for DIEP harvesting and vaginal reconstruction. No flap necrosis occurred. One patient in the VRAM (vertical rectus abdominis myocutaneous) group experienced a late incisional hernia and one patient in the DIEP flap group required revision for vaginal stenosis. In our experience, DIEP flap represents our preferred choice of flap for circumferential vaginal reconstruction after PE. To achieve a high reproducibility, the technically demanding pedicled vertical DIEP flap has to be harvested by a trained surgeon, after strict evaluation of the preoperative imaging with identification and localization of perforator vessels.
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France. Electronic address: ferron.gwenael@iuct-oncolople.fr.
authors.forename: Gwénael
authors.initials: G
authors.lastname: Ferron
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Gangloff
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Department of Surgical Oncology, Institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Frigenza
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Departement of Gynecology, Hospital Universitari Germans Trias y Pujol, Carretera de Canyet, 08916 Badalona, Barcelona, Spain.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Torrent
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Picaud
authors.affiliation: Departement of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gladieff
authors.affiliation: Departement of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
authors.affiliation: Department of Surgical Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Mery
authors.affiliation: Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Berenice
authors.initials: B
authors.lastname: Boulet
authors.affiliation: Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Gisele
authors.initials: G
authors.lastname: Balague
authors.affiliation: Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Martinez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects / Q000379:methods*; D061525:Perforator Flap; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
keywords: DIEP; Pelvic exenteration; VRAM; Vaginal reconstruction