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Techniques in Coloproctology

Published in:

01-10-2012 | Original Article

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

Authors: C. Sahakitrungruang, P. Atittharnsakul

Published in: Techniques in Coloproctology | Issue 5/2012

Abstract

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.

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Title: Colonic flap with mucosa removed: a novel technique for pelvic reconstruction after exenteration of advanced pelvic malignancy
Authors: C. Sahakitrungruang
P. Atittharnsakul
Publication date: 01-10-2012
Publisher: Springer Milan
Published in: Techniques in Coloproctology / Issue 5/2012
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-012-0865-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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