Plastic reconstructive surgery techniques using VRAM or gracilis flaps in order to successfully treat complex XXXX .

@entity1 @entity322 @entity5 @entity292 @entity790 @entity130
BACKGROUND: Urogenital @entity292 are devastating complications occurring after @entity5 or @entity130 . Surgical treatment is challenging. Thus, further surgical repair options are needed for treatment of complex @entity292 within the pelvic region. METHODS: Twelve @entity1 with @entity790 were surgically treated in our department from 2004 to 2012. These selected cases fulfilled eligibility criteria for continence-preserving surgery -  a history of @entity292 recurrences with @entity322 after receiving at least two surgical attempts. Five VRAM and eight gracilis flaps were used to cover up given tissue defects and to perform functional continence-preserving reconstruction with mean follow-up of 6.3 years. Data were retrospectively reviewed, and standardized survey was performed to evaluate quality of life of all living @entity1 (n  =  10). RESULTS: In all cases, final surgical treatment of the given fistulae by VRAM or gracilis flaps could be achieved, with mean operating time of 5:31  h (range: 4:50-6:48  h) for VRAM flap and 3:11  h (range: 2:04-4:42  h) for gracilis flap. Outcome measures were primarily to avoid @entity292 recurrence after plastic surgical treatment, and secondary quality of life and survival. All @entity1 had their continence preserved, but two @entity1 died during follow-up period. Postoperative assessment revealed the following: VRAM flap @entity1 (n  =  3) showed slight incontinence during the follow-up period, whereas continence was restored in all @entity1 with gracilis flap reconstruction (n  =  7). Quality-of-life assessment indicated restoration of quality of life in comparison to general population ( @entity1  >  @entity1 ). Furthermore, key points of the two presented surgical techniques are demonstrated in detail. CONCLUSION: With preformed VRAM or gracilis flaps, complex @entity790 can be successfully eradicated and continence is restored. The main focus should be the recovery of quality of life, which could be successfully regained. Nevertheless, the continence success rate has to be defined on an individual, case-by-case basis. LEVEL OF EVIDENCE: Original work, cohort study level III.
