Abstract
Introduction
Pelvic floor defects following pelvic exenteration constitute a challenge to the reconstructive surgeon. Whenever the common reconstruction options such as the gluteus maximus myocutaneous flap (GLM) and the vertical rectus abdominis myocutaneous flap (VRAM) are not feasible, free tissue transfer will be the only remaining option. Being one of the most reliable and versatile flaps used for microsurgical reconstruction, the free latissimus dorsi (LD) muscle flap provides an adequate solution to this problem.
Patients and methods
We describe our experience with 12 consecutive patients who underwent the free transfer of LD free flap for secondary reconstruction of the pelvic floor and perineum following pelvic exenteration for management of locally advanced pelvic malignancies in Klinikum Oldenburg from 2007 to 2014.
Results
Recurrent cancer of the anal canal was the most common pathology necessitating the performance of pelvic exenteration. Thrombosis of the vascular anastomosis was reported in two cases and ended with total flap loss in one of them. Functional limitations arose in two patients postoperatively. The mean hospital stay was 25 days.
Conclusion
Free LD myocutaneous flap provides an adequate solution for reconstruction of pelvic defects resulting from radical oncological resections in cases where the use of locoregional flaps, such as the gluteus maximus flap and the vertical rectus abdominis flap, is not feasible because of an extensive defect, disruption of the vascular pedicle, or due to planning for bilateral stomas placement.
Similar content being viewed by others
References
Bullard KM, Trudel JL, Baxter NN et al (2005) Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 48:438–443
Christian CK, Kwaan MR, Betensky RA et al (2005) Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum 48:43–48
Petrelli N, Rosenfield L, Herrera L et al (1986) The morbidity of perineal wounds following abdominoperineal resection for rectal carcinoma. J Surg Oncol 32:138–140
Shibata D, Hyland W, Busse P et al (1999) Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum. Ann Surg Oncol 6:33–37
Rothenberger DA, Wong WD (1992) Abdominoperineal resection for adenocarcinoma of the low rectum. World J Surg 16:478–485
Wibe A, Eriksen MT, Syse A et al (2005) Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level. Br J Surg 92:217–224
Nisar PJ, Scott HJ (2009) Myocutaneous flap reconstruction of pelvis after abdominoperineal excision. Color Dis 11(8):806–816
McCraw JB, Massey FM, Ahanklin KD et al (1976) Vaginal reconstruction with gracilis myocutaneous flaps. Plast Reconstr Surg 58:176–183
Taylor GI, Corlett R, Boyd JB (1983) The extended deep inferior epigastric flap: a clinical technique. Plastreconstr Surg 72:751–765
Holm T, Ljung A, Häggmark T et al (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238
Wagstaff MJ, Rozen WM, Whitaker IS et al (2009) Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps. Microsurgery 29(8):626–629
Vermaas M, Ferenschild FT, Hofer SO et al (2005) Primary and secondary reconstruction after surgery of the irradiated pelvis using a gracilis muscle flap transposition. Eur J Surg Oncol 31(9):1000–1005
Tomita K, Yano K, Nishibayashi A et al (2013) The role of latissimus dorsi myocutaneous flaps in secondary breast reconstruction after breast-conserving surgery. Eplasty 13, e28
Kim YH, Youn SK, Kim JT et al (2011) Treatment of the severely infected frontal sinus with latissimus dorsi myocutaneous free flaps. J Craniofac Surg 22(3):962–966
Girod A, Boissonnet H, Jouffroy T et al (2012) Latissimus dorsi free flap reconstruction of anterior skull base defects. J Craniomaxillofac Surg 40(2):177–179
Abdou A, Bruns H, Troja A et al (2015) Plastische Deckung ausgedehnter Defekte nach exenterativen Eingriffen im Becken. Zentralbl Chir 140:214–218
Rudolph R, Vande BJ, Schneider JA et al (1988) Slowed growth of cultured fibroblasts from human radiation wounds. Plast Reconstr Surg 82(4):669–677
Krueger WW, Goepfert H, Romsdahl M et al (1987) Fibroblast implantation enhances wound healing as indicated by breaking strength determinations. Otolaryngology 86(5):804–811
Kaartinen IS, Vuento MH, Hyoty MK et al (2015) Reconstruction of the pelvic floor and the vagina after total pelvic exenteration using the transverse musculocutaneous gracilis flap. J Plast Reconstr Aesthet Surg 68:93–97
Riediger D, Schmelzle R (1986) Modifizierte Anwendung des myokutanenLatissimusdorsi-Lappens zur Defektdeckung im Mund- Kiefer- Gesichtsbereich. Dtsch Z Mund Kiefer Gesichts Chir 10:364–374
Kieran I, Nugent N, Riordain MO et al (2012) Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report. Ann R Coll Surg Eng 94:254–256
Kraybill WG, Reinsch J, Puckett CL et al (1984) Pelvic abscess following preoperative radiation and abdominoperineal resection: management with a free flap. J Surg Oncol 25:18–20
Petrie NC, Chan JK, Chave H et al (2010) The inferior mesenteric vessels as recipients when performing free tissue transfer for pelvic defects following abdomino-perineal resection. A novel technique and review of intra-peritoneal recipient vessel options for microvascular transfer. J Plast Reconstr Aesthet Surg 63:133–140
Lin CT, Chen SG, Chen TM et al (2011) Successful management of osteoradionecrotic precoccygeal defect with the free latissimus dorsi muscle flap: case report and literature review. Microsurgery 6:490–494
Stechl NM, Baumeister S, Grimm K (2011) Microsurgical reconstruction of the pelvic floor after pelvic exenteration. Reduced morbidity and improved quality of life by an interdisciplinary concept. Chirurg 82(7):625–630
Petrie N, Branagan G, McGuiness C et al (2009) Reconstruction of the perineum following anorectal cancer excision. Int J Color Dis 24:97–104
Miller MJ, Schusterman MA, Reece GP et al (1993) Interposition vein grafting in head and neck reconstructive microsurgery. J Reconstr Microsurg 9(3):245–251
Adams WP, Lipschitz AH, Ansari M et al (2004) Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg 53(1):6–11
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abdou, A.H., Li, L., Khatib-Chahidi, K. et al. Free latissimus dorsi myocutaneous flap for pelvic floor reconstruction following pelvic exenteration. Int J Colorectal Dis 31, 385–391 (2016). https://doi.org/10.1007/s00384-015-2402-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-015-2402-8