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The use of previously irradiated pedicled flaps for vaginal reconstruction

International Journal of Impotence Research volume 32, pages 264–266 (2020)Cite this article

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Vaginal reconstruction is critical for maintenance of sexual functioning, psychosocial health, body image restoration, and for pelvic support to prevent bladder, rectal, and pelvic prolapse. The combination of radiotherapy and need of vaginal reconstruction poses a challenge for the reconstructive genital surgeon. Surgical reconstruction of an irradiated field would conventionally consist of using healthy, non-irradiated tissue. This can be performed by either free or pedicled flap surgery. However, when previous reconstruction has failed, reconstructive options become more limited. In selected cases, local pedicled flaps may be considered, however, these are located in the field of irradiation. When previously irradiated tissue is used as pedicled flap, there is an increased risk of flap complications. Though we would not recommend standard use of previously irradiated flaps, we do feel that there is a place for them in selected cases. With the known risk of poor wound healing and fistula formation, it is important to discuss the (non)surgical options and adventitious risks with the patient thoroughly and to practice shared decision making.

Vaginal reconstruction after oncological gyncological surgery with or without radiotherapy is of vital importance for sexual function, psychological health, body image, and pelvic support [1]. Radiotherapy is important as adjuvant, non-surgical, postoperative treatment in various gynecological malignancies.

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Fig. 1: Use of a previously irratiated pudendal thigh flap for secondary vaginal reconstruction.
Fig. 2

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, location VUMC, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands

    Müjde Özer & Wouter B. van der Sluis

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  1. Müjde Özer
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  2. Wouter B. van der Sluis
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Correspondence to Wouter B. van der Sluis.

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Özer, M., van der Sluis, W.B. The use of previously irradiated pedicled flaps for vaginal reconstruction. Int J Impot Res 32, 264–266 (2020). https://doi.org/10.1038/s41443-020-0255-3

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