401 Primary flap closure of perineal defects after pelvic exenteration in gynecologic malignancies: an overview of a debated topic

Introduction/Background Pelvic exenteration (PE) is a surgical procedure performed as salvage treatment in patients with recurrent or persistent gynaecological cancers. Radical alteration of pelvis and pelvic floor anatomy cause often major complications. Fortunately, PE can be combined with reconstructive techniques to decrease complications and reduce postoperative morbility and mortality. Many options for reconstructive surgery have been described, especially a wide spectrum of surgical flaps. Various criteria have been suggested for the selection of patients undergoing primary closure of perineal defect flaps; however, none have conclusively identified the optimal choice. Methodology The aim of our study was to focus on technical aspects and the advantages and disadvantages of reconstructive technique, providing an overview of those most frequently used for the treatment of pelvic floor defects after PE. Results Flaps based on the deep inferior epigastric artery, especially vertical rectus abdominis musculocutaneous (VRAM) flaps, and gracilis muscle flaps, are the most common reconstructive techniques used for pelvic floor and vaginal reconstruction (figure 1). The first type of flap has the advantage of providing a large amount of tissue to reconstruct the perineum or vagina but has the disadvantage of interfering with the integrity of the abdominal wall. Gracilis flaps do not create abdominal wall defects but the lack of perforators, which causes poor perfusion reliability of the skin pad, small muscle volume and limited excursion are its most important limitations. Conclusion In our opinion, reconstructive surgery may be considered in case of total or type II/III PE and in patients submitted to prior pelvic irradiation. VRAM could be used to close extended defects at the time of PE, while gracilis flaps can be used in case of VRAM complications (figure 2). As these techniques will continue to evolve, it is recommended to adopt an integrated, multidisciplinary approach within a tertiary medical center. Disclosures Authors declare to have no disclosures.