Bilaterale gestielte M. gracilis-Lappenplastik und bilaterale M. gluteus-Rotationslappenplastik zur mehrzeitigen Rekonstruktion der Vagina, des kleinen Beckens sowie der Perinealregion

Zusammenfassung

Die plastische Rekonstruktion onkologischer, anorektaler Defekte ist aufgrund der erheblichen bakteriellen Kontamination, einer neoadjuvanten Radio-Chemotherapie sowie den anatomisch sehr schwierigen Bedingungen häufig kompliziert und führt zu einer prolongierten Hospitalisation der Patienten. Einen Goldstandard für die plastische Rekonstruktion gibt es nicht. Wir stellen eine Patientin vor, welche nach der Diagnose eines distalen Rektumkarzinoms mit Infiltration des Anus und der Scheidenhinterwand eine radikale Tumorexzision mit Rektum-, Anus- und Vaginateilresektion erhielt, wobei es postoperativ zu einer schweren nekrotisierenden Infektion kam. Es resultierte ein großflächiger, tiefreichender vollschichtiger Weichteildefekt des kleinen Beckens und der Perinealregion. Wir präsentieren eine retrospektive klinische Beurteilung und Fotodokumentation einer Rekonstruktion der Vagina, des kleinen Beckens sowie des Gesäßes durch eine bilaterale M.-gracilis- und M.-gluteus-Lappenplastik.

Abstract

Plastic reconstructions of oncological anorectal defects often prove to be very difficult and lead to prolonged hospitalisation due to severe bacterial contamination, neoadjuvant radiotherapy and chemotherapy and difficult anatomical conditions. There is no common standard for plastic reconstruction in such cases. We present a patient diagnosed with distal rectal cancer with infiltration of the anus and vagina, who underwent radical tumour resection of the rectum and anus as well as partial resection of the vagina. A severe necrotising infection occurred post-surgery, which resulted in an extensive defect of the pelvis and perineal region. This article provides a retrospective clinical evaluation and photographic documentation of the reconstruction of the vagina, pelvis and perineal region with a bilateral gracilis and gluteus muscle flap.

Schlüsselwörter

Vaginale Rekonstruktion - bilaterale M.-gracilis-Lappenplastik - Becken - gestielte Lappenplastiken

Key words

Vaginal reconstruction - bilateral M. gracilis-flap - pelvis - perineal - pedicled flap

Publication History

Received: 27 July 2020

Accepted: 29 June 2021

Article published online:
23 September 2021

• Literatur

• 1 Weichman KE, Matros E, Disa JJ. Reconstruction of Peripelvic Oncologic Defects. Plast Reconstr Surg 2017; 140 (04) 601e-612e
• 2 Guarner F, Malagelada JR. Gut flora in health and disease. Lancet 2003; 361: 512-519
• 3 Althumairi AA, Canner JK, Gearhart SL. et al. Predictors of perineal wound complications and prolonged time to perineal wound healing after abdomino-perineal resection. World J Surg 2016; 40: 1755-1762
• 4 Krautz C, Weber K, Croner R. et al. Cylindric abdominoperineal rectum exstirpation with partial vulvar and vaginal resection as well as perineal and vaginal defect reconstruction by a Vertical Rectus Abdominis Myocutaneous (VRAM) flap. Zentralbl Chir 2017; 142: 543-547
• 5 Sawan D, Bosc R, La Padula S. et al. Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note. Ann Chir Plast Esthet 2020; 65: e1-e5 Epub 2020 Jun 11. PMID: 32536474
• 6 Hainsworth A, Al Akash M, Roblin P. et al. Perineal reconstruction after abdominoperineal excision using inferior gluteal artery perforator flaps. Br J Surg 2012; 99: 584-588 Epub 2012 Jan 9. PMID: 22231559
• 7 Horch RE, Ludolph I, Cai A. et al. Interdisciplinary Surgical Approaches in Vaginal and Perineal Reconstruction of Advanced Rectal and Anal Female Cancer Patients. Front Oncol 2020; 10: 719
• 8 Brodbeck R, Horch RE, Arkudas A. et al. Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects. Front Oncol 2015; 5: 212 Published 2015 Oct 8.
• 9 McArdle A, Bischof DA, Davidge K. et al. Vaginal reconstruction following radical surgery for colorectal malignancies: A systematic review of the literature. Ann Surg Oncol 2012; 19: 3933-3942
• 10 John HE, Jessop ZM, Di Candia M. et al. An algorithmic approach to perineal reconstruction after cancer resection: Experience from two international centers. Ann Plast Surg 2013; 71: 96-102
• 11 Horch RE, Ludolph I, Cai A. et al. Interdisciplinary Surgical Approaches in Vaginal and Perineal Reconstruction of Advanced Rectal and Anal Female Cancer Patients. Front Oncol 2020; 10: 719 Published 2020 May 13.
• 12 Matschke J, Armbruster R, Reeps C. et al. AV loop free flap: an interdisciplinary approach for perineal and sacral defect reconstruction after radical oncological exenteration and radiation in a colorectal cancer patient. World J Surg Oncol 2019; 17: 154 Published 2019 Sep 2.