Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes
Identifieur interne : 003B34 ( Pmc/Curation ); précédent : 003B33; suivant : 003B35Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes
Auteurs : Bien-Keem Tan [Singapour] ; Gavin Chun-Wui Kang [Singapour] ; Eng Hseon Tay [Singapour] ; Yong Chen Por [Singapour]Source :
- Archives of Plastic Surgery [ 2234-6163 ] ; 2014.
Abstract
Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction.
From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps.
The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis.
We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.
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DOI: 10.5999/aps.2014.41.4.379
PubMed: 25075361
PubMed Central: 4113698
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wicri:curation="lc">Singapour</country><wicri:regionArea>Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Tay, Eng Hseon" sort="Tay, Eng Hseon" uniqKey="Tay E" first="Eng Hseon" last="Tay">Eng Hseon Tay</name><affiliation wicri:level="1"><nlm:aff id="A2">Thomson Women Cancer Centre, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Thomson Women Cancer Centre</wicri:regionArea></affiliation></author><author><name sortKey="Por, Yong Chen" sort="Por, Yong Chen" uniqKey="Por Y" first="Yong Chen" last="Por">Yong Chen Por</name><affiliation wicri:level="1"><nlm:aff id="A3">Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25075361</idno><idno type="pmc">4113698</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113698</idno><idno type="RBID">PMC:4113698</idno><idno type="doi">10.5999/aps.2014.41.4.379</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">003B35</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003B35</idno><idno type="wicri:Area/Pmc/Curation">003B34</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003B34</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes</title><author><name sortKey="Tan, Bien Keem" sort="Tan, Bien Keem" uniqKey="Tan B" first="Bien-Keem" last="Tan">Bien-Keem Tan</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Kang, Gavin Chun Wui" sort="Kang, Gavin Chun Wui" uniqKey="Kang G" first="Gavin Chun-Wui" last="Kang">Gavin Chun-Wui Kang</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Tay, Eng Hseon" sort="Tay, Eng Hseon" uniqKey="Tay E" first="Eng Hseon" last="Tay">Eng Hseon Tay</name><affiliation wicri:level="1"><nlm:aff id="A2">Thomson Women Cancer Centre, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Thomson Women Cancer Centre</wicri:regionArea></affiliation></author><author><name sortKey="Por, Yong Chen" sort="Por, Yong Chen" uniqKey="Por Y" first="Yong Chen" last="Por">Yong Chen Por</name><affiliation wicri:level="1"><nlm:aff id="A3">Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Singapour</country><wicri:regionArea>Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital</wicri:regionArea></affiliation></author></analytic><series><title level="j">Archives of Plastic Surgery</title><idno type="ISSN">2234-6163</idno><idno type="eISSN">2234-6171</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction.</p></sec><sec><title>Methods</title><p>From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps.</p></sec><sec><title>Results</title><p>The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis.</p></sec><sec><title>Conclusions</title><p>We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hockel, M" uniqKey="Hockel M">M Hockel</name></author><author><name sortKey="Dornhofer, N" uniqKey="Dornhofer N">N Dornhofer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shamini, N" uniqKey="Shamini N">N Shamini</name></author><author><name sortKey="Tay, Eh" uniqKey="Tay E">EH Tay</name></author><author><name sortKey="Ho, Th" uniqKey="Ho T">TH Ho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Ec" uniqKey="Wang E">EC Wang</name></author><author><name sortKey="Kwah, Yc" uniqKey="Kwah Y">YC Kwah</name></author><author><name sortKey="Tan, Wp" uniqKey="Tan W">WP Tan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rutledge, F" uniqKey="Rutledge F">F Rutledge</name></author><author><name sortKey="Sinclair, M" uniqKey="Sinclair M">M Sinclair</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Julian, Cg" uniqKey="Julian C">CG Julian</name></author><author><name sortKey="Callison, J" uniqKey="Callison J">J Callison</name></author><author><name sortKey="Woodruff, Jd" uniqKey="Woodruff J">JD Woodruff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wee, Jt" uniqKey="Wee J">JT Wee</name></author><author><name sortKey="Joseph, Vt" uniqKey="Joseph V">VT Joseph</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Tn" uniqKey="Wang T">TN Wang</name></author><author><name sortKey="Whetzel, T" uniqKey="Whetzel T">T Whetzel</name></author><author><name sortKey="Mathes, Sj" uniqKey="Mathes S">SJ Mathes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccraw, Jb" uniqKey="Mccraw J">JB McCraw</name></author><author><name sortKey="Massey, Fm" uniqKey="Massey F">FM Massey</name></author><author><name sortKey="Shanklin, Kd" uniqKey="Shanklin K">KD Shanklin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Sh" uniqKey="Chen S">SH Chen</name></author><author><name sortKey="Hentz, Vr" uniqKey="Hentz V">VR Hentz</name></author><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shepherd, Jh" uniqKey="Shepherd J">JH Shepherd</name></author><author><name sortKey="Van Dam, Pa" uniqKey="Van Dam P">PA Van Dam</name></author><author><name sortKey="Jobling, Tw" uniqKey="Jobling T">TW Jobling</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hashimoto, I" uniqKey="Hashimoto I">I Hashimoto</name></author><author><name sortKey="Nakanishi, H" uniqKey="Nakanishi H">H Nakanishi</name></author><author><name sortKey="Nagae, H" uniqKey="Nagae H">H Nagae</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Pk" uniqKey="Lee P">PK Lee</name></author><author><name sortKey="Choi, Ms" uniqKey="Choi M">MS Choi</name></author><author><name sortKey="Ahn, St" uniqKey="Ahn S">ST Ahn</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Arch Plast Surg</journal-id><journal-id journal-id-type="iso-abbrev">Arch Plast Surg</journal-id><journal-id journal-id-type="publisher-id">APS</journal-id><journal-title-group><journal-title>Archives of Plastic Surgery</journal-title></journal-title-group><issn pub-type="ppub">2234-6163</issn><issn pub-type="epub">2234-6171</issn><publisher><publisher-name>The Korean Society of Plastic and Reconstructive Surgeons</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25075361</article-id><article-id pub-id-type="pmc">4113698</article-id><article-id pub-id-type="doi">10.5999/aps.2014.41.4.379</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Tan</surname><given-names>Bien-Keem</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Gavin Chun-Wui</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tay</surname><given-names>Eng Hseon</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Por</surname><given-names>Yong Chen</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.</aff><aff id="A2"><label>2</label>Thomson Women Cancer Centre, Singapore.</aff><aff id="A3"><label>3</label>Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore.</aff><author-notes><corresp>Correspondence: Bien-Keem Tan. Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608. Tel: +65-63214686, Fax: +65-62259340, <email>bienkeem@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>15</day><month>7</month><year>2014</year></pub-date><volume>41</volume><issue>4</issue><fpage>379</fpage><lpage>386</lpage><history><date date-type="received"><day>05</day><month>6</month><year>2014</year></date><date date-type="rev-recd"><day>11</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>11</day><month>7</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 The Korean Society of Plastic and Reconstructive Surgeons</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Background</title><p>Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction.</p></sec><sec><title>Methods</title><p>From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps.</p></sec><sec><title>Results</title><p>The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis.</p></sec><sec><title>Conclusions</title><p>We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.</p></sec></abstract><kwd-group><kwd>Vulvar</kwd><kwd>Carcinoma</kwd><kwd>Surgical flaps</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>Algorithm for reconstruction of vulvar defect</p></caption><graphic xlink:href="aps-41-379-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p>Intraoperative positioning for vulvar reconstruction</p><p>Intraoperative positioning of patient on Allen Yellofin stirrups. The knees are extended and stirrups hinged in a manner that allows adduction of the hips to reduce tension on the flaps during inset. The buttocks are exposed for the elevation of gluteal fold flaps in this case.</p></caption><graphic xlink:href="aps-41-379-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p>A case of myocutaneous gracilis transposition flap</p><p>Right vulvar squamous cell cancer in a 61-year-old (case 18). (A) Hemivulvectomy defect with pubic bone exposed and dead space to fill. (B) Right myocutaneous gracilis flap with its slender distal muscular end. (C) Flap was transposed and inset with distal muscle filling deep bony cavity; donor site was closed primarily; the result shown at one year postoperatively.</p></caption><graphic xlink:href="aps-41-379-g003"></graphic></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><p>A case of myocutaneous gracilis transposition flap</p><p>Vulvar cancer in a 74-year-old (case 2). (A) Vulvectomy defect. (B) Left myocutaneous gracilis flap. (C) Flap was transposed and inset into defect and donor site was closed primarily; the result shown at one year postoperatively.</p></caption><graphic xlink:href="aps-41-379-g004"></graphic></fig><fig id="F5" orientation="portrait" position="float"><label>Fig. 5</label><caption><p>A case of bilateral gracilis VY-advancement flaps</p><p>Paget's disease of the vulva in a 60-year-old (case 36). Bilateral gracilis VY-advancement flap reconstruction one year postoperatively showing a patent well-centered urethral meatus as a result of careful periurethral inset of the flaps.</p></caption><graphic xlink:href="aps-41-379-g005"></graphic></fig><fig id="F6" orientation="portrait" position="float"><label>Fig. 6</label><caption><p>A case of vertical rectus myocutaneous flap</p><p>Post-reconstruction with left vertical rectus myocutaneous flap at 6 months follow-up in a 45-year-old patient who had sarcoma (case 22). Note colostomy was sited to the right (instead of usual left) to facilitate optimal wound coverage with an ipsilateral rectus flap.</p></caption><graphic xlink:href="aps-41-379-g006"></graphic></fig><fig id="F7" orientation="portrait" position="float"><label>Fig. 7</label><caption><p>A case of gluteal fold transposition flap</p><p>Paget's disease of the right vulva in a 63-year-old (case 11). (A) Vulvectomy defect with perforators dopplered. (B) Right gluteal fold flap. (C) Flap was transposed and inset into defect and donor site was closed primarily; the result shown at one year postoperatively with a well-concealed donor-site in the gluteal crease.</p></caption><graphic xlink:href="aps-41-379-g007"></graphic></fig><fig id="F8" orientation="portrait" position="float"><label>Fig. 8</label><caption><p>A case of bilateral gluteal fold VY-advancement flaps</p><p>Post-reconstruction with bilateral gluteal fold VY-advancement flaps at 1 year follow-up in a 51-year-old patient (case 24) who had bilateral Paget's disease of the vulva.</p></caption><graphic xlink:href="aps-41-379-g008"></graphic></fig><fig id="F9" orientation="portrait" position="float"><label>Fig. 9</label><caption><p>A case of gracilis muscle flap and skin grafting</p><p>An 83-year-old patient (case 17) who had vulvar carcinoma. Post-reconstruction with a right gracilis muscle flap and skin grafting; at one year follow-up showing a patent introitus and vaginal vault.</p></caption><graphic xlink:href="aps-41-379-g009"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Please write a short heading</p></caption><graphic xlink:href="aps-41-379-i001"></graphic></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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