American Association of Plastic Surgeons

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102nd AAPS Annual Meeting
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Improving Reconstructive Outcomes of Female Peri-pelvic Oncologic Defects
Ashley Shin, BS1, Rami Elmorsi M.D2, Christopher Nguyen, MD2, Jessie Z Yu, MD2, Donald P Baumann, MD, FACS2, Margaret S Roubaud, MD1
1University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA, 2University of Texas MD Anderson Cancer Center, Houston, TX, USA

PurposeReconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, operative resection margins, and subsequent wound healing risks. Functional restoration requires thoughtful perioperative management focused on both defect reconstruction and patient reported outcomes.
MethodsA retrospective chart review of peripelvic defect reconstruction in female patients at MD Anderson Cancer Center from 2008 to 2023. Data collected included the patient comorbidities, tumor characteristics, and reconstructive details. Complications were classified as non-operative or operative within 30 days. Patient outcomes included survival, hernia rates, sexual activity, and need for revision.
ResultsIn the time period, 150 adult patients received reconstruction of peripelvic defects. At resection, most had primary diagnosis of colorectal (68.8%) or gynecologic malignancy (13.8%), although 11.3% presented for post-treatment fistula or stricture. Neoadjuvant radiation was present in 80% of patients and comorbidities were common, including Class II or III obesity in 33.8%. The most common resection requiring reconstruction was abdominoperineal resection with partial vaginectomy (45%). The most common reconstructive technique was a pedicled flap (41.25%) or pedicled flap with incisional hernia repair (43.75%). The majority (87.5%) of patients did not require revisions. Complications occurred in 56%, although only 5% required operative intervention including hernia (1.3%). At last follow-up, approximately 10% of patients reported they were sexually active. Of those who received vaginal dilator therapy instruction (25%), 50% were sexually active.
ConclusionsPeri-pelvic soft tissue reconstruction in the oncologic population is safe, even in comorbid patients with neoadjuvant therapy. Return to sexual activity is higher when given dilator therapy instruction.


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