Vaginal Reconstruction after Cancer Treatment
HERSANT B | R Bosc | C Touboul
DOI number : 10.26299/51nq-e927/emem.2018.1.004
Abstract
Vaginal reconstruction is a surgical challenge based on multidisciplinary. The objective is at the same time therapeutic, functional and morphological since the reconstruction allows, on the one hand, the filling of the pelvic dead space in cases of exenteration thus reducing post-operative complications (fistulas, occlusion, infection), and on the other hand, the maintenance of a morphological and functional female body pattern close to normal.
The choice of reconstruction technique depends firstly on the partial or total nature of the colpectomy and the isolated or associated nature of the excision (pelvic exenteration). It also depends on the quality of adjacent tissues (radiotherapy) and the approach used for excision (laparoscopic, vaginal, laparotomy).
Advances in vaginal reconstruction include the use of custom-tailored perforating flaps harvested while preserving the rectus abdominis muscles.
In fact, 3D imaging in volume rendering and augmented reality of the perforating vessels of the upright muscles allows the removal of cutaneous fat flaps at the expense of the lower epigastric vessels (DIEP-SIEP) vascularized on a perforator while preserving the functional integrity of the abdominal wall.
The advances are also based on the evaluation of the intraoperative reliability and the monitoring of these flaps by indocyanine green angiography allowing the evaluation of vascularization by fluorescence.
New approaches of vaginal reconstruction are also being evaluated using tissue engineering (Scaffold) and stem cell by adding stem cells.
The choice of reconstruction technique depends firstly on the partial or total nature of the colpectomy and the isolated or associated nature of the excision (pelvic exenteration). It also depends on the quality of adjacent tissues (radiotherapy) and the approach used for excision (laparoscopic, vaginal, laparotomy).
Advances in vaginal reconstruction include the use of custom-tailored perforating flaps harvested while preserving the rectus abdominis muscles.
In fact, 3D imaging in volume rendering and augmented reality of the perforating vessels of the upright muscles allows the removal of cutaneous fat flaps at the expense of the lower epigastric vessels (DIEP-SIEP) vascularized on a perforator while preserving the functional integrity of the abdominal wall.
The advances are also based on the evaluation of the intraoperative reliability and the monitoring of these flaps by indocyanine green angiography allowing the evaluation of vascularization by fluorescence.
New approaches of vaginal reconstruction are also being evaluated using tissue engineering (Scaffold) and stem cell by adding stem cells.