This study compares the outcome of Singapore flap, vertical rectus abdominus musculocutaneous flap (VRAM), and gracilis musculocutaneous flap vaginal reconstruction. A retrospective review of 99 consecutive patients was conducted at the Mayo Clinic from January 1988 to October 2001. All possible complications were determined for each of the 3 flap reconstructions. Univariate analysis of the effects of radiation and smoking on the complication rate for each flap was determined. Preoperative and postoperative sexual function and adequacy were compared between each group. Ninety-nine patients ranging in age from 19 to 80 years (mean 51.6 years) were compared with a mean follow up of 28.9 months. There were 36 deaths during the follow up period at a mean of 22.3 months (32/36 due to recurrent or metastatic carcinoma). Forty-one VRAM, 13 Gracilis, and 45 Singapore flaps (24 included an additional omental flap) were used for vaginal reconstruction. The majority was due to acquired vaginal defects due to recurrent pelvic malignancy. The overall complication rate was lower following VRAM than either gracilis or Singapore flap (13/41 31.7%, 8/13 61.5%, 21/45 46.7% respectively). The flap specific complication rate was superior in the VRAM group as well (9/41 22%, 7/13 53.8%, 17/45 37.8% respectively). VRAM reconstruction had a lower complication rate in patients receiving radiation therapy (8/36 22.2%, 6/12 50%, 16/35 45.7% respectively). The risks of either small bowel obstruction or vaginal fistula following vaginal reconstruction was lower following VRAM. Preoperative sexual participation predicted postoperative participation in 75/88 patients (85.2%) and was not affected by the type of reconstruction although more patients with a Singapore flap required frequent vaginal dilatation to maintain vaginal patency. The VRAM has the lowest overall and flap related complication rate with equivalent outcomes. It has become our vaginal reconstructive flap of choice.
View Synopsis (.doc format, 21.0 kb)