Jinekolojik Onkolojik Cerrahi Sonrası Oluşan Vulva ve Perine Defektlerinin Rekonstrüksiyonu ve Lokal Fleplerin Etkinliği

Year 2021, Volume: 23 Issue: 2, 164 - 169, 30.08.2021

Tolga Aksan , Ateş Karateke , Orkun Uzuneyüpoğlu , Muhammed Beşir Öztürk , Mehmet Küçükbaş

https://doi.org/10.18678/dtfd.911107

Cited By: 1

Abstract

Amaç: Jinekolojik malignitelerin radikal cerrahisi sonrası çoğu defekt primer sütüre edilerek kapatılabilse de rekonstrüksiyon gerektiren geniş defektler oluştuğunda farklı rekonstrüksiyon seçenekleri de mevcuttur. Bu çalışmada, vulva ve perine bölgesinde jinekolojik kanser nedeniyle rezeksiyon sonrası rekonstrüksiyon uygulanan hastalarda uyguladığımız tedavi strateji ve sonuçları sunulmaktadır.
Gereç ve Yöntemler: Bu geriye dönük çalışmaya Mayıs 2017 ve Temmuz 2020 arasında rekonstrüksiyon uygulanan toplam 18 hasta dahil edildi. Hastaların demografik ve klinik bilgileri rezeksiyon operasyonu, defekt özellikleri, uygulanan rekonstrüksiyon yöntemleri değerlendirildi. Operasyon sonrası tedavi stratejisi ve komplikasyon oranları değerlendirildi.
Bulgular: Hastaların ortalama yaşı 62,3±13,2 (42-83) yıl olarak saptandı. Hastaların %88,9’unda ek hastalık bulunmaktaydı. Beş (%27,8) hastada pelvik egzantasyon, 2 (%11,1) hastada anterior rezeksiyon ve 11 (%61,1) hastada vulvektomi uygulanmıştı. En sık görülen malignite skuamöz hücreli karsinom ve ortalama defekt genişliği 106±97 (12-476) cm2 olarak saptandı. On altı (%88,9) hastada lokal fasyokutan flep, bir (%5,6) hastada pediküllü rektus myokutan flebi ve bir (%5,6) hastada deri grefti ile onarım yapıldı. Beş (%27,8) hastada yara yeri komplikasyonları, bir (%5,6) hastada parsiyel flep nekrozu ve uzun vadede bir (%5,6) hastada nüks gelişti.
Sonuç: Jinekolojik onkolojik rezeksiyonlar sonrası vulva ve perine defektlerinin birçoğunun lokal flepler ile başarılı bir şekilde kapatılması mümkündür. Özellikle vulvektomi hastalarında bölgenin özellikleri ve hasta komorbiditeleri dikkate alındığında uzamış yara yeri problemleri görülebileceği akılda bulundurulmalıdır.

Keywords

Vulvektomi, Pelvik egzantrasyon, Rekonstrüktif, neoplazm, Morbidite, Yara

Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

Abstract

Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum.
Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated.
Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm2. Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term.
Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients.

Keywords

vulvectomy, pelvic exenteration, reconstructive, neoplasm, morbidity, wounds

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