Читать книгу Surgical Management of Advanced Pelvic Cancer - Группа авторов - Страница 21

In the original series, after the exenteration was performed, the pelvis was generally packed and allowed to heal by secondary intention. Later, surgeons closed the perineum in two layers, to prevent the small intestine prolapsing into the pelvic cavity [1]. In recent decades, various techniques for filling the “dead‐space” have been examined. The omental pedicle flap was reported as an adjunct in keeping the small bowel and urinary conduit from prolapsing into the pelvic cavity, with the hope of reducing fistula rates [68, 69]. In addition, the use of mesh reconstruction of the pelvic inlet, colonic advancement, and locoregional myocutaneous flaps have been advocated with varying degrees of success (Figure 1.5) [70–72]. The use of flaps in particular was an important development that simultaneously allowed closure of perineal wounds not amenable to primary closure and transfer of viable tissue into the pelvis to decrease septic and perineal complications [73, 74]. Moreover, myocutaneous flaps may be used to construct a neovagina [75, 76].

Figure 1.4 Diagrams from the first description by Wanebo and Marcove of abdomino‐prone sacral resection showing the extent of resection required for recurrence of rectal cancer in the posterior compartment (A), lines of transection of the sacrum from the posterior approach (B), the operative defect after sacral resection (C), and rotational skin flaps for wound closure (D). Copyright © 1981 J.B. Lippincott Company.

Source: Reproduced with permission from Wolters Kluwer [49].