title: Pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after pelvic exenterations.
abstract: To describe the technique and report experiences with pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after extensive pelvic procedures.
  
  
  
  Surgical technique of MRAM harvest and transposition is carefully described. The patients in whom pelvic floor reconstruction with MRAM after either infralevator pelvic exenteration and/or extended lateral pelvic sidewall excision was carried out were enrolled into the study (MRAM group, n=16). Surgical data, post-operative morbidity, and disease status were retrospectively assessed. The results were compared with a historical cohort of patients, in whom an exenterative procedure without pelvic floor reconstruction was performed at the same institution (control group, n=24).
  
  
  
  Both groups were balanced in age, BMI, tumor types, and previous treatment. Substantially less patients from the MRAM group required reoperation within 60days of the surgery (25% vs. 50%) which was due to much lower rate of complications potentially related to empty pelvis syndrome (1 vs. 7 reoperations) (p=0.114). Late post-operative complication rate was substantially lower in the MRAM group (any grade: 79% vs. 44%; grade≥3: 37% vs. 6%) (p=0.041). The performance status 6months after the surgery was ≤1 in the majority of patients in MRAM (81%) while in only 38% of patients from the control group (p=0.027). There was one incisional hernia in MRAM group while three cases were reported in the controls.
  
  
  
  Pelvic floor reconstruction by MRAM in patients after pelvic exenterative procedures is associated with a substantial decrease in postoperative complications that are potentially related to empty pelvis syndrome.
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic. Electronic address: d_cibula@yahoo.com.
authors.forename: D
authors.initials: D
authors.lastname: Cibula
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Zikan
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Fischerova
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Kocian
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Germanova
authors.affiliation: Department of Radiodiagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Burgetova
authors.affiliation: Institute for Biostatistics and Analyses; Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Dusek
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Z
authors.initials: Z
authors.lastname: Fartáková
authors.affiliation: Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Schneiderová
authors.affiliation: Department of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: K
authors.initials: K
authors.lastname: Nemejcová
authors.affiliation: Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Slama
mesh_terms: 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*; D017773:Pelvic Floor / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps
keywords: Empty pelvic syndrome; Muscular flap; Pelvic exenteration; Pelvic floor reconstruction