Sunday, October 10, 2004
5667

The rectus abdominis musculoperitoneal flap for the immediate reconstruction of partial vaginal defects

Liza C. Wu, MD and David H. Song, MD, FACS.

Partial defects of the vagina, after tumor ablative surgery or fistula repair, are often closed directly. Primary closure of these wounds can be achieved without technical difficulty; however, constriction of the vaginal canal can be an untoward sequelae. To prevent this complication, the authors present the application of the rectus abdominis musculoperitoneal flap for the immediate reconstruction of partial vaginal defects in five patients. Two patients had locally advanced rectal cancer and underwent abdominal perineal resection with en bloc vaginectomies. One patient had a pelvic sarcoma and also had an abdominal perineal resection with en bloc vaginectomy. One patient had a vesiculovaginal fistula after radical cystectomy and neobladder reconstruction and underwent debridement of the vesiculovaginal fistula. The last patient had a rectovaginal fistula from Crohn’s colitis; she underwent a total proctocolectomy and debridement of the rectovaginal fistula. Four patients had posterior defects, and one patient had an anterolateral defect. The average size of the defect was 16 cm2. All patients were reconstructed using either a right or left sided rectus abdominis musculoperitoneal flap based on the deep inferior epigastric vessels. Follow up ranges from four months to one year. All five patients recovered without significant morbidity or mortality. There were no total or partial flap necroses. There were no hernia occurrences. There were no fistula (re)occurrences. One patient had a donor site wound infection that was debrided and successfully treated with the vacuum-assisted closure device™. Vaginal reconstruction was assessed clinically. The peritoneum became indistinguishable from the surrounding mucosa. Adequate length and width was maintained. Sexual function and activity resumed in all but one patient.