Incorporating pelvic/vaginal reconstruction into radical pelvic surgery.

OBJECTIVE: The objective of this review is to discuss the more common surgical scenarios that often require pelvic/vaginal reconstruction with an emphasis on incorporating reconstructive options into the pelvic exenteration.

METHODS: A review of the literature regarding pelvic/vaginal reconstruction in patients undergoing radical pelvic surgery was performed and supplemented with the authors' own experience.

RESULTS: Reconstructive surgical procedures are often necessary with outcome goals that include any combination of enhanced wound healing, decrease in acute and chronic morbidity, and restoration of anatomic form and function. Many reconstruction techniques are available including, but not limited to, skin grafting, simple tissue transposition flaps, fasciocutaneous flaps, and myocutaneous flaps. It is extremely important that the gynecologic oncologist be proficient with more than one of the reconstructive options available to address the various pelvic/vaginal defects one may encounter. There is a wide range in the complexity of surgical situations requiring reconstruction. The pelvic exenteration in the previously radiated patient offers the highest level of challenge in terms of pre-operative planning, intra-operative decision-making and surgical skills. Vaginal reconstruction for sexual intercourse may be a priority for some patients, however pelvic/vaginal reconstruction plays a major role in facilitating wound healing, minimizing significant morbidity, and improving patient quality of life and functional outcomes.

CONCLUSIONS: The gynecologic oncologist is best suited to orchestrate this multifaceted surgical process. It is extremely important that the gynecologic oncologist be well versed in the reconstructive options available in order that it is optimally planned and effected at the primary surgical procedure.