Colonic flap with mucosa removed: a novel technique for pelvic reconstruction after exenteration of advanced pelvic malignancy

Background Immediate reconstruction after pelvic exenteration is challenging. Several flap techniques, such as the vertical rectus abdominis musculocutaneous flap and the gracilis flap, have been reported. However, flap-specific complications have been documented. Instead of harvesting the myocutane...

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Bibliographic Details
Published in:Techniques in coloproctology 2012-10, Vol.16 (5), p.373-378
Main Authors: Sahakitrungruang, C., Atittharnsakul, P.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Colon, Sigmoid - surgery
Colon, Sigmoid - transplantation
Colorectal Surgery
Female
Gastroenterology
Humans
Intestinal Mucosa - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Operative Time
Original Article
Pelvic Exenteration
Pelvic Neoplasms - surgery
Proctology
Retrospective Studies
Surgery
Surgical Flaps - adverse effects
Surgical Flaps - surgery
Surgical Flaps - transplantation
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Summary:Background Immediate reconstruction after pelvic exenteration is challenging. Several flap techniques, such as the vertical rectus abdominis musculocutaneous flap and the gracilis flap, have been reported. However, flap-specific complications have been documented. Instead of harvesting the myocutaneous flap from the abdomen or legs, our group has proposed a colonic flap for neovaginal reconstruction especially for rectal cancer with vaginal invasion. Nevertheless, the application of a colonic flap for individuals needing only vascularized tissue to fill up the pelvic dead space is problematic. The aim of this study was to demonstrate this novel technique. Methods There were eight patients: three rectal cancers, one vulvar cancer with synchronous rectal cancer, one malignant nerve sheath tumor, one cervical cancer, one prostate cancer, and one rectal gastrointestinal stromal tumor. The operations included four total pelvic exenterations, three total pelvic exenterations with S3-sacrectomy, and one total pelvic exenteration with S3-sacrectomy and left nephrectomy. A colonic flap from which the mucosa was removed was used for immediate pelvic reconstruction in all patients. The flap detail involved harvesting the segment of sigmoid colon with low ligation of the inferior mesenteric artery, spatulation of the antimesenteric side of the flap, and mucosectomy. The flap was sutured to the pelvic sidewall with the mucosa-removed surface facing toward the pelvic defect. Results There were no intraoperative complications, and free surgical margins were achieved. Two patients developed a fluid collection, which was successfully treated with percutaneous drainage. Perineal wound complications were not found. None of the patients developed incisional hernias or perineal hernias at the follow-up. Conclusions Immediate pelvic reconstruction with mucosa-removed colonic flap is technically feasible and straightforward. This technique provides good outcomes.
ISSN:1123-6337
1128-045X
DOI:10.1007/s10151-012-0865-y