Advertisement
Research Article| Volume 65, ISSUE 5, P629-633, May 2012

The propeller flap concept used in vaginal wall reconstruction

Published:December 02, 2011DOI:https://doi.org/10.1016/j.bjps.2011.11.010

      Summary

      Most posterior vaginal wall defects are due to abdominoperineal resection for colorectal carcinoma involving the posterior vaginal wall or resection of local malignancies. The rectus abdominis myocutaneous flap, the modified Singapore flap and the gracilis myocutaneous flap remain workhorse solutions for this type of vaginal reconstruction. The introduction of the perforator concept has introduced new therapeutic options using the gluteal donor site region. Recently, perforator-based gluteal flaps have been described as a reliable solution for reconstruction of posterior vaginal wall defects, with low donor site morbidity. Here, we present a new technique to optimise results and minimise morbidity to the patient.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Okaro A.C.
        • Worthington T.
        • Stebbing J.F.
        • et al.
        Curative resection for low rectal adenocarcinoma: abdomino-perineal vs anterior resection.
        Colorectal Dis. 2006; 8: 645-659
        • Bakx R.
        • van Lanschot J.J.
        • Zoetmulder F.A.
        Inferiorly based rectus abdominis myocutaneous flaps in surgical oncology: indications, technique, and experience in 37 patients.
        J Surg Oncol. 2004; 85: 93-97
        • Bell S.W.
        • Dehni N.
        • Chaouat M.
        • et al.
        Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection.
        Br J Surg. 2005; 92: 482-486
        • McCraw J.B.
        • Massey F.M.
        • Shanklin K.D.
        • et al.
        Vaginal reconstruction with gracilis myocutaneous flaps.
        Plast Reconst Surg. 1976; 58: 176-183
        • Shibata D.
        • Hyland W.
        • Busse P.
        • et al.
        Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum.
        Ann Surg Oncol. 1999; 6: 33-37
        • Boccola M.A.
        • Rozen W.M.
        • Ek E.W.
        • et al.
        Inferior gluteal artery myocutaneous island transposition flap reconstruction of irradiated perineal defects.
        J Plast Reconstr Aesthet Surg. 2010; 63: 1169-1175
        • Germann G.
        • Cedidi C.
        • Petracic A.
        • Kallinowski F.
        • Herrfarth C.
        The partial gluteus maximus musculocutaneous turnover flap. An alternative concept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall.
        Br J Plast Surg. 1998; 51: 620-623
        • Carr M.M.
        • Manktelow R.T.
        • Zuker R.M.
        Gracilis donor site morbidity.
        Microsurgery. 1995; 16: 598-600
        • Lejour M.
        • Dome M.
        Abdominal wall function after rectus abdominis ransfer.
        Plast Reconstr Surg. 1991; 87: 1054-1068
        • Wee J.T.
        • Joseph V.T.
        A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report.
        Plast Reconstr Surg. 1989; 83: 701-709
        • Yii N.W.
        • Niranjan N.S.
        Lotus petal flaps in vulvo-vaginal reconstruction.
        Br J Plast Surg. 1996; 49: 547-554
        • Sawada M.
        • Kimata Y.
        • Kasamatsu T.
        • et al.
        Versatile lotus petal flap for vulvoperineal reconstruction after gynecological ablative surgery.
        Gynecol Oncol. 2004; 95: 330-355
        • Geddes C.R.
        • Morris S.F.
        • Neligan P.C.
        Perforator flaps: evolution, classification, and applications.
        Ann Plast Surg. 2003; 50: 90-99
        • LoTempio M.M.
        • Allen R.J.
        Breast reconstruction with SGAP and IGAP flaps.
        Plast Reconstr Surg. 2010; 126: 393-401
        • Koshima I.
        • Moriguchi T.
        • Soeda S.
        • Kawata S.
        • Ohta S.
        • Ikeda A.
        The gluteal perforator-based flap for repair of sacral pressure sores.
        Plast Reconstr Surg. 1993; 91: 678-683
        • Leow M.
        • Lim J.
        • Lim T.C.
        The superior gluteal artery perforator flap for the closure of sacral sores.
        Singapore Med J. 2004; 45: 37-39
        • Acarturk T.O.
        • Parsak C.K.
        • Sakman G.
        • et al.
        Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus.
        J Plast Reconstr Aesthet Surg. 2010; 63: 133-139
        • Wagstaff M.J.
        • Rozen W.M.
        • Whitaker I.S.
        • et al.
        Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps.
        Microsurgery. 2009; 29: 626-629
        • Teo T.C.
        The propeller flap concept.
        Clin Plast Surg. 2010; 37: 615-626
        • Korambayil P.M.
        • Allalasundaram K.
        • Balakrishnan T.
        Perforator propeller flaps for sacral and ischial soft tissue reconstruction.
        Indian J Plast Surg. 2010; 43: 151-157
        • Jakubietz R.G.
        • Jakubietz D.F.
        • Zahn R.
        • Schmidt K.
        • Meffert R.H.
        • Jakubietz M.G.
        Reconstruction of pressure sores with perforator-based propeller flaps.
        J Reconstr Microsurg. 2011; 27: 195-198
        • Cordeiro P.G.
        • Pusic A.L.
        • Disa J.J.
        A classification system and reconstructive algorithm for acquired vaginal defects.
        Plast Reconstr Surg. 2002; 110: 1058-1065
        • Tobin G.R.
        • Day T.G.
        Vaginal and pelvic reconstruction with distally based rectus abdominis myocutaneous flaps.
        Plast Reconstr Surg. 1988; 81: 62-73
        • Tobin G.R.
        • Pursell S.H.
        • Day Jr., T.G.
        Refinements in vaginal reconstruction using rectus abdominis flaps.
        Clin Plast Surg. 1990; 17: 705-712
        • Coquerel-Beghin D.
        • Milliez P.Y.
        • Auquit-Auckbur I.
        • et al.
        The gracilis musculocutaneous flap: vascular supply of the muscle and skin components.
        Surg Radiol Anat. 2006; 28: 588-595
        • West N.P.
        • Finan P.J.
        • Anderin C.
        • et al.
        Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer.
        J Clin Oncol. 2008; 21: 3617-3622