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

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sahakitrungruang, C. Atittharnsakul, P.
Description	Country affiliation: Thailand Author Affiliation: Sahakitrungruang C ( Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. chucheep@hotmail.com)
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.
File Format	HTM / HTML
ISSN	11236337
Issue Number	5
Volume Number	16
e-ISSN	1128045X
Journal	Techniques in Coloproctology
Language	English
Publisher	Springer
Publisher Date	2012-10-01
Publisher Place	Italy
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline General Surgery Discipline Gastroenterology Colon, Sigmoid Transplantation Pelvic Exenteration Pelvic Neoplasms Surgery Surgical Flaps Adult Aged Female Humans Intestinal Mucosa Male Middle Aged Operative Time Retrospective Studies Adverse Effects Journal Article
Content Type	Text
Resource Type	Article
Subject	Gastroenterology Surgery

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