闭孔动脉跨区供血的长型股薄肌肌皮瓣即时重建癌切除后的女阴阴道缺损

Immediate Vulvovaginal Reconstruction with the Long Gracilis Myocutaneous Flap Supplied by Obturator Artery

目的探讨女阴阴道癌扩大根治术后即时进行修复再造的方法。方法应用闭孔动脉跨区供血的股薄肌肌皮瓣对女阴阴道癌切除后的缺损进行即时的修复与重建。肌皮瓣的肌肉组织可充填癌切除后的组织缺损,皮肤组织则可修复创面和再造阴道。术中还可对癌切后的创面直接进行放射治疗。结果临床应用4例,其中1例术中进行放疗。全部转移的肌皮瓣均100%成活,切口甲级愈合,再造的外阴及阴道无挛缩,外观酷似正常,性功能如常。结论闭孔动脉跨区供血的长型股薄肌肌皮瓣,不仅具有与传统股薄肌肌皮瓣相同的修复机能,而且由于其蒂部在耻骨闭孔处,故转移弧度更广,更适合会阴癌切除后的修复再造,也不影响术前、术中和术后进行放疗和化疗。

Objective To explore the technique of immediate vulvovaginal reconstruction after the modified radical resection of vulvovaginal cancer.Methods The long gracilis myocutaneous flap supplied by obturator artery was used for the immediate vulvovaginal reconstruction after the modified radical resection of vulvovaginal cancer.The musle part of the myocutaneous flap filled the dead space after the modified radical vulvectomy.The skin of the flap was used to cover the skin defect and reconstruct the vagina.If necessary,the patients received intraoperative radiotherapy.Results The flaps were successfully applied in 4 cases with 100% survival rate.The appearance and function of reconstructed vulva and vagina was almostly normal.Conclusion The long gracilis myocutaneous flap supplied by obturator artery is the same useful for vulvovaginal reconstruction as the traditional gracilis myocutaneous flap.With the pedicle located at the obturator of pubis,the flaps allow a more widely arc for rotation.It is more suitable for the female vulvovaginal reconstruction and the pre-,intra-,and post-operative radiotherapy and chemotherapy can be also performed.