Outcomes of partial vaginal reconstruction with pedicled flaps following oncologic resection

Background: Immediate flap reconstruction for partial vaginal resection is often performed with resection of colorectal, gynecologic, and urologic malignancies. Surgical and functional outcomes have not been well described. The aim of the authors' study was to identify factors associated with improved outcomes in patients undergoing immediate flap reconstruction for partial vaginal resection. Methods: The authors reviewed all consecutive partial vaginal resections with immediate flap reconstruction at their institution between 2000 and 2009. Patient, treatment, and outcome data were collected and retrospectively analyzed. Logistic regression was used to evaluate predictive factors associated with complications. Results: Seventy-two women were included in the study. Mean follow-up was 32 months (range, 1 to 93 months). The most common pathology was rectal adenocarcinoma (63 percent); 89 percent of patients underwent preoperative radiotherapy and 87 percent preoperative chemotherapy. Most vaginal defects were located posteriorly (72 percent) and reconstructed with vertical rectus abdominis myocutaneous flaps (87 percent). Readmission or reoperation was required in 8 percent of patients. Complications were higher in patients who received preoperative radiotherapy than in those who did not (66 versus 25 percent) and who had posterior defects rather than anterior defects (66 versus 30 percent). Patients experiencing postoperative complications had higher preoperative radiation doses (p = 0.014). Of 24 patients with available postoperative sexual function data, 68 percent reported successful penile-vaginal intercourse. Conclusions: Immediate flap reconstruction for partial vaginal resection has a high incidence of minor complications. Preoperative radiotherapy is associated with increased complications. Most patients able to practice penile-vaginal intercourse preoperatively also could postoperatively. For patients undergoing pelvic oncologic resection, immediate flap reconstruction for partial vaginal resection should be considered; however, counseling on relevant risks and functional outcomes is vital.