• Fabian A Holman, Ingrid S Martijnse, Marjan J Traa, Dorry Boll, Grard A Nieuwenhuijzen, Ignace H de Hingh, and Harm J Rutten.
• Department of Surgery, St Elisabeth Hospital, Tilburg, The Netherlands.
• Dis. Colon Rectum. 2013 Feb 1; 56 (2): 175-85.

BackgroundSurgery for locally advanced and recurrent rectal carcinoma sometimes requires partial resection of the perineum and/or vagina necessitating subsequent reconstruction.ObjectiveThe aim of this study was to describe the surgical and functional outcomes of reconstructing the vagina and/or the perineum by using the vertical rectus abdominis myocutaneous flap and to evaluate the health status of patients who received reconstruction.DesignThis is a retrospective cohort study.SettingsThis study was conducted at a tertiary referral hospital for locally advanced and recurrent rectal cancer.PatientsPatients receiving multimodality treatment for primary or recurrent locally advanced rectal carcinomas were included.Main Outcome MeasuresFirst, the surgical outcome was assessed. Second, 10 female patients who received vaginal reconstruction underwent a gynecological examination including biopsies. Finally, quality of life was assessed and compared with patients who underwent treatment for rectal carcinoma without a reconstruction.ResultsFifty-one patients underwent reconstruction of the dorsal vagina and/or the perineum with the use of a vertical rectus abdominis myocutaneous flap. In 13 patients, the flap was used to close a perineal defect; in 26 patients, to close a vaginal defect; and in 12 patients, to close both. In 3 patients, partial necrosis of the flap occurred that was treated conservatively. In 4 patients, stenosis of the introitus occurred, as found in the gynecological examination. Biopsies confirmed epithelialization of the vaginal wall. All groups reported good functioning and low symptom burden. After vaginal reconstruction, women reported equal or higher scores on global health status, emotional functioning, and body image.LimitationsThe lack of information on the health status of the patients before the start of treatment prohibits making causal inferences in health status over time.DiscussionReconstruction of the perineum and/or dorsal vagina was successful in all patients. Surgeons and gynecologists who use the vertical rectus abdominis myocutaneous flap should be aware of stenosis of the vaginal introitus. Gynecological consultation at an early stage should be standard.

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