Perineal Reconstruction



10.1055/b-0034-97727

Perineal Reconstruction

Noopur Gangopadhyay & Ida K. Fox
(a-b) A 44-year-old woman with recurrent vulvar cancer has just undergone wide local excision of tumor and now requires 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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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Perineal Reconstruction
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