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- 저자 : Stefano Gentileschi (검색결과 1 건)
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Surgical therapy of vulvar cancer: how to choose the correct reconstruction?
Stefano Gentileschi,Maria Servillo,Giorgia Garganese,Simona Fragomeni,Francesca De Bonis,Giovanni Scambia,Marzia Salgarello 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.6
Objective: To create a comprehensive algorithmic approach to reconstruction after vulvarcancer ablative surgery, which includes both traditional and perforator flaps, evaluatinganatomical subunits and shape of the defect. Methods: We retrospectively reviewed 80 cases of reconstruction after vulvar cancerablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. Weregistered the possibility to achieve the complete wound closure, even in presence of verycomplex defects, and the postoperative complications. On the basis of these experience,analyzing the choices made and considering the complications, we developed an algorithmto help with the selection of the flap in vulvoperineal reconstruction after oncologic ablativesurgery for vulvar cancer. Results: We employed eight types of different flaps, including 54 traditional fasciocutaneousV-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Ygracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, twoLimberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and onesuperficial circumflex iliac artery perforator flap. The structures most frequently involvedin resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely,rectum, bladder, and lower abdominal wall. Conclusion: The algorithm we implemented can be a useful tool to help flap selection. Thekey points in the decision-making process are: anatomical subunits to be covered, overallshape and symmetry of the defect and some patient features such as skin laxity or previousradiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperinealreconstruction, although in some cases traditional flaps remain the best choice.
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