Purpose. To compare flap-specific complications of rectus abdominis myocutane ous (RAM) and myoperitoneal (RAMP)-flap neovagina reconstructions performed con currently with radical pelvic procedures. Materials and met...Purpose. To compare flap-specific complications of rectus abdominis myocutane ous (RAM) and myoperitoneal (RAMP)-flap neovagina reconstructions performed con currently with radical pelvic procedures. Materials and methods. Retrospective s ingle institution chart review of all patients with RAM or RAMP flap neovaginal reconstructions performed on a Gynecologic Oncology service, 1988-2003. Analysi s for associations with flap-specific morbidity was performed. Results. Neovagi nal reconstructions comprised 32 RAM and 7 RAMP flaps. Twenty-two (69%) RAM pa tients underwent total pelvic exenteration compared to 1 (14%) RAMP patient (P < 0.013). Overall, 33 (85%) of the patient population had previously been treat ed with radiation. Flap-specific complications developed in 12 (32%) RAM versu s 4 (57%) of the RAMP patients (P > 0.1). Donor site complications and incision al hernias were increased in RAMP patients (both P < 0.03), with trends for incr easing risk of vaginal stricture/stenosis and superficial wound sepa-rations (b oth P < 0.1). Complete vaginal stenosis developed in only 1 (3%) RAM versus 3 ( 43%) RAMP patients. Furthermore, 3 RAMP patients developed complete stenosis wh en the vaginal defect was circumferential and involved > 65%of the vagina while this did not occur in 22 similar RAM patients (P < 0.0005). Only patients with partial longitudinal defects maintained vaginal patency after RAMP flap. Fifteen (58%)-of 26 patients surviving >12 months reported coitus, with no significan t difference between the groups. Conclusions. When there is circumferential loss of the upper 2/3 of the vagina. RAMP flaps are not suitable for neovaginal reco nstruction after radical pelvic surgery because of an increased risk of vaginal stenosis compared to RAM flaps. Patients with partial longitudinal vaginal defec ts, however, may have successful neovaginal reconstruction with RAMP flaps.展开更多
文摘Purpose. To compare flap-specific complications of rectus abdominis myocutane ous (RAM) and myoperitoneal (RAMP)-flap neovagina reconstructions performed con currently with radical pelvic procedures. Materials and methods. Retrospective s ingle institution chart review of all patients with RAM or RAMP flap neovaginal reconstructions performed on a Gynecologic Oncology service, 1988-2003. Analysi s for associations with flap-specific morbidity was performed. Results. Neovagi nal reconstructions comprised 32 RAM and 7 RAMP flaps. Twenty-two (69%) RAM pa tients underwent total pelvic exenteration compared to 1 (14%) RAMP patient (P < 0.013). Overall, 33 (85%) of the patient population had previously been treat ed with radiation. Flap-specific complications developed in 12 (32%) RAM versu s 4 (57%) of the RAMP patients (P > 0.1). Donor site complications and incision al hernias were increased in RAMP patients (both P < 0.03), with trends for incr easing risk of vaginal stricture/stenosis and superficial wound sepa-rations (b oth P < 0.1). Complete vaginal stenosis developed in only 1 (3%) RAM versus 3 ( 43%) RAMP patients. Furthermore, 3 RAMP patients developed complete stenosis wh en the vaginal defect was circumferential and involved > 65%of the vagina while this did not occur in 22 similar RAM patients (P < 0.0005). Only patients with partial longitudinal defects maintained vaginal patency after RAMP flap. Fifteen (58%)-of 26 patients surviving >12 months reported coitus, with no significan t difference between the groups. Conclusions. When there is circumferential loss of the upper 2/3 of the vagina. RAMP flaps are not suitable for neovaginal reco nstruction after radical pelvic surgery because of an increased risk of vaginal stenosis compared to RAM flaps. Patients with partial longitudinal vaginal defec ts, however, may have successful neovaginal reconstruction with RAMP flaps.
