OBJECTIVE: We describe a modification of the traditional vertical rectus abdominis myocutaneous flap for neovagina creation and our experience to date. METHODS: Our modified vertical rectus abdominis myocutaneous flap...OBJECTIVE: We describe a modification of the traditional vertical rectus abdominis myocutaneous flap for neovagina creation and our experience to date. METHODS: Our modified vertical rectus abdominis myocutaneous flap uses a smaller flap size with a full-thickness skin graft posteriorly to decrease the size of the abdominal wall defect. We have used the modified vertical rectus abdominis myocutaneous flap in 18 patients between March 1998 and March 2004 to create a neovagina after exenterative surgery. RESULTS: The mean age of the patients was 54 years, and the mean body mass index was 27 (range 18-44). Twelve patients underwent a total pelvic, 5 anterior, and 1 posterior exenteration. Among the 13 patients requiring a colostomy, the vertical rectus abdominis myocutaneous flap was taken from the contralateral side. In these patients, the urostomy was brought out on the vertical rectus abdominis myocutaneous flap donor side. There has been only 1 partial flap loss, which eventually resulted in a fully epithelialized neovagina. Eight patients at last follow-up were sexually active. Two other patients have died from recurrent disease, and 2 are alive with recurrence. The other 6 patients have no evidence of recurrent disease and, although not sexually active at the time of this report, have a viable and adequate neovagina. All patients had a successful primary closure of the abdominal wound in a vertical fashion. Three patients had superficial abdominal wound breakdown, which healed by secondary intention. CONCLUSION: The modified vertical rectus abdominis myocutaneous flap allows for creation of an adequate neovagina with a smaller abdominal wall defect.展开更多
目的:探讨腹壁成形术对于产后腹壁松弛患者的治疗效果。方法:回顾性分析2017年3月-2019年3月在蚌埠市第三人民医院行腹壁成形术的患者15例,年龄(35.7±5.75)岁,均为女性。于术前、术后2周、术后6个月测量并记录患者经髂前上棘腹围...目的:探讨腹壁成形术对于产后腹壁松弛患者的治疗效果。方法:回顾性分析2017年3月-2019年3月在蚌埠市第三人民医院行腹壁成形术的患者15例,年龄(35.7±5.75)岁,均为女性。于术前、术后2周、术后6个月测量并记录患者经髂前上棘腹围、体重指数,观察患者术后并发症发生情况、腹壁美容效果以及患者手术满意度。术后随访6个月~1年。结果:15例患者均成功施行手术,术后腹壁松弛得以修复,术后2周经髂前上棘腹围为(79.2±4.93)cm,较术前(94.8±5.22)cm明显缩小,差异有统计学意义(P<0.05)。术后体重指数(Body mass index,BMI)为(22.2±1.77)kg/m2,较术前BMI(22.8±1.85)kg/m2有所减小,差异有统计学意义(P<0.05)。所有患者均无血清肿、感染、血肿、切口裂开、皮肤坏死等并发症发生。嘱患者控制体重,术后6个月腹围无明显增加。结论:腹壁成形术可明显改善产后腹壁松弛患者腹部外形,减小患者腹围和BMI,术后患者满意度高,对于产后腹壁松弛患者具有一定临床意义。展开更多
文摘OBJECTIVE: We describe a modification of the traditional vertical rectus abdominis myocutaneous flap for neovagina creation and our experience to date. METHODS: Our modified vertical rectus abdominis myocutaneous flap uses a smaller flap size with a full-thickness skin graft posteriorly to decrease the size of the abdominal wall defect. We have used the modified vertical rectus abdominis myocutaneous flap in 18 patients between March 1998 and March 2004 to create a neovagina after exenterative surgery. RESULTS: The mean age of the patients was 54 years, and the mean body mass index was 27 (range 18-44). Twelve patients underwent a total pelvic, 5 anterior, and 1 posterior exenteration. Among the 13 patients requiring a colostomy, the vertical rectus abdominis myocutaneous flap was taken from the contralateral side. In these patients, the urostomy was brought out on the vertical rectus abdominis myocutaneous flap donor side. There has been only 1 partial flap loss, which eventually resulted in a fully epithelialized neovagina. Eight patients at last follow-up were sexually active. Two other patients have died from recurrent disease, and 2 are alive with recurrence. The other 6 patients have no evidence of recurrent disease and, although not sexually active at the time of this report, have a viable and adequate neovagina. All patients had a successful primary closure of the abdominal wound in a vertical fashion. Three patients had superficial abdominal wound breakdown, which healed by secondary intention. CONCLUSION: The modified vertical rectus abdominis myocutaneous flap allows for creation of an adequate neovagina with a smaller abdominal wall defect.
文摘目的:探讨腹壁成形术对于产后腹壁松弛患者的治疗效果。方法:回顾性分析2017年3月-2019年3月在蚌埠市第三人民医院行腹壁成形术的患者15例,年龄(35.7±5.75)岁,均为女性。于术前、术后2周、术后6个月测量并记录患者经髂前上棘腹围、体重指数,观察患者术后并发症发生情况、腹壁美容效果以及患者手术满意度。术后随访6个月~1年。结果:15例患者均成功施行手术,术后腹壁松弛得以修复,术后2周经髂前上棘腹围为(79.2±4.93)cm,较术前(94.8±5.22)cm明显缩小,差异有统计学意义(P<0.05)。术后体重指数(Body mass index,BMI)为(22.2±1.77)kg/m2,较术前BMI(22.8±1.85)kg/m2有所减小,差异有统计学意义(P<0.05)。所有患者均无血清肿、感染、血肿、切口裂开、皮肤坏死等并发症发生。嘱患者控制体重,术后6个月腹围无明显增加。结论:腹壁成形术可明显改善产后腹壁松弛患者腹部外形,减小患者腹围和BMI,术后患者满意度高,对于产后腹壁松弛患者具有一定临床意义。
