Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery.
OBJECTIVE
Ablative surgery for vulvar cancer can involve the resection of perineum, vagina, urethra, groins, mons pubis, and abdominal wall creating complex defects. In our opinion, ALT flap is an ideal flap for reconstruction, because of low incidence of complications, long pedicle outside the radiotherapy field, capability of carrying fascia and muscle, possibility of sensate reconstruction, and low donor site morbidity. The purpose of this report is to describe our experience with ALT flap for reconstruction after vulvar cancer extirpative surgery, discussing our indications for complex defects and focusing on its versatility.


METHODS
We performed a retrospective review of 15 cases of complex postoncologic gynecological wounds, reconstructed with 16 pedicled ALT flap, after vulvar cancer ablative surgery between 2014 and 2016. Age of the patients ranged from 44 to 77, with mean age of 62.6. Postoperative outcomes were evaluated.


RESULTS
The flap size ranged from 12 × 8 cm to 22 × 15 cm., in two cases we harvested vastus lateralis to fill the dead space after pelvic exenteration. In nine flaps, we could include only 1 perforator, in 7 we could use two, 5 were septocutaneous and 18 myocutaneous with a pedicle length ranging from9cm.to15cm.We had no flap necrosis.3 flaps showed dehiscence of a part of the wound that healed by dressings. In one case of obese patient the donor site showed partial wound edge necrosis, and required secondary grafting. During follow-up that ranged from 1 month to 2 years, cancer relapsed locally in 5 patients. Global performance and specific pain improved after surgery.


CONCLUSIONS
ALT flap should be included in the first line options for reconstructions of complex defects resulting from vulvar cancer surgery because of its reliability and versatility. © 2016 Wiley Periodicals, Inc. Microsurgery 37:516-524, 2017.
Department of Plastic and Reconstructive Surgery, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Stefano
S
Gentileschi
Department of Plastic and Reconstructive Surgery, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Maria
M
Servillo
Department of Gynecology, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Giorgia
G
Garganese
Department of Gynecology, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Fragomeni
F
Simona
Department of Gynecology, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Giovanni
G
Scambia
Department of Plastic and Reconstructive Surgery, Catholic University Sacred Heart, Policlinico Agostino Gemelli, Largo Agostino Gemelli 1, Rome, Italy.
Marzia
M
Salgarello
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013848:Thigh / Q000601:surgery; D016896:Treatment Outcome; D014844:Vulva / Q000601:surgery; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology*