Perineal Reconstruction
Description
Wide resection of perineal contents, including mons pubis, vulva, and clitoris.
Resection area extends to urethral and vaginal orifices.
Work-up
History
Personal or family history of cancer.
Previous radiation treatment or exposure.
Previous urinary incontinence.
Physical examination
Evaluate surgical defect and classify as partial (anterior, lateral, posterior, upper two-thirds) or total loss of vagina.
Evaluate for dead space, hernias, fistulas, infection, devascularized tissue, regional lymphadenopathy; examine abdomen and lower extremities to assess possible reconstructive options.
Assess radiation effects to surrounding tissues.
Pertinent imaging or diagnostic studies
Assess transferrin, albumin, and prealbumin levels.
Computed tomography to evaluate nodal spread in the pelvis.
Positron emission tomography (PET) has improved sensitivity to detect small nodal metastasis.
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