Abstract

RODRIGUEZ-VEGAS, José Manuel et al. Reconstruction of extended pelvic/perineal exenteration defect with a composite latissimus dorsi-scapular-parascapular free flap and a mesh. The rationale behind the technique. Cir. plást. iberolatinoam. [online]. 2020, vol.46, n.4, pp.465-470.  Epub Feb 08, 2021. ISSN 1989-2055.  https://dx.doi.org/10.4321/s0376-78922020000500010.

The article reports the functional, reconstructive rationale behind a case of extended pelvic exenteration. Our aim is to analyze the surgical defect and consequent reconstructive requirements, aspects which have not been adequately addressed in the literature.

A case is presented of a 62-year-old man presenting with an 82x117x108 mm perineal squamous cell carcinoma of urethral origin invading bladder, pelvic bone and pararectal fossa. The resection defect was reconstructed with a composite latissimus dorsi-scapular-parascapular flap and a bilayer mesh (polypropylene and extended polytetrafluoroethylene).

A multiplanar reconstruction is shown that addresses 3 distinct functional requirements: 1.- visceral support to prevent perineal herniation; 2.- collapse of dead space to minimize the risk of infection; and 3.- a stable skin cover for a demanding area.

With no postoperative short or long-term complications, the patient is ambulating and free of disease at one-year follow-up.

To the best of the authors' knowledge, this is the first report of the described composite flap in the reconstruction of the pelvic exenteration defect.

Keywords : Pelvic exenteration; Lasissimus dorsi flap; Scapular flap; Parascapular flap; Mesh.

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