Zusammenfassung
Fragestellung: Die zunehmende Inzidenz an Vulvakarzinomen in den letzten Jahren lässt die Anzahl
an Patientinnen, die mit plastisch-rekonstruktiven Verfahren an der Vulva versorgt
werden müssen, ansteigen. Material und Methodik: Zwischen 2004 und 2009 wurden 20 Frauen mit primären bzw. rezidivierten Vulva-/Vaginalkarzinomen,
ausgedehnter VIN/AIN, großen Defekten nach Wundheilungsstörungen oder Scheidenstenose
mit 24 Lappenplastiken operiert. Dazu wurden 9 distante (6 VRAM, 2 M. gracilis und
ein M. tensor fasciae latae) und 15 regionäre Lappen eingesetzt (8 Gluteal Fold, 4
Transpositionslappen, 3 Singapore-Flaps). Bei den distanten Lappen war die Indikation
in der Regel ein großer Defekt nach Rezidiventfernung, bei den lokoregionären Lappen
kleinere Defekte und Erhalt der Vita sexualis bei jungen Patientinnen mit Vulvakarzinom
der hinteren Kommissur. Ergebnisse: Der VRAM-Lappen erwies sich als sehr verlässlicher Lappen zur Defektdeckung im Mons-pubis-Bereich
und bei großen Defekten im gesamten Vulvabereich, der Gluteal-Fold-Flap wurde zur
Rekonstruktion größerer Defekte lateral und dorsal verwendet, der Singapore-Flap zur
Rekonstruktion der Vagina und bei periurethralen Defekten. Transpositionslappen helfen,
Introitusverengungen bei Läsionen an der hinteren Kommissur zu verhindern. Ein individualisiertes
Vorgehen nach Einzelbefund ist ausschlaggebend für den Erfolg. Die Rate schwerer Komplikationen
in unserer Serie war sehr gering. Schlussfolgerung: Wir schlussfolgern, dass die individualisierte Lappendeckung an der Vulva in der
Hand von plastisch-rekonstruktiv erfahrenen operativ tätigen Gynäkologen ein sicherer
Eingriff zum Erhalt der Sexualfunktion und Deckung von großen Defekten nach Rezidiventfernung
von Malignomen darstellt.
Abstract
Purpose: The rising incidence of vulvar cancer in the last decades has led to an increasing
number of plastic reconstructions for vulvar/vaginal defects. Material and Methods: Between 2004 and 2009, 20 women with primary or recurrent vulvar/vaginal cancer,
extensive VIN/AIN, large defects after wound infections or vaginal stenosis were treated
with 25 vulvar flaps. We used 9 distant flaps (6 VRAM, two M. gracilis and one M. tensor
fasciae latae flap) and 15 regional flaps (8 gluteal fold, 4 fasciocutaneous and 3
Singapore flaps). The major indication to use a distant flap was closure of large
defects in recurrent vulvar cancer; locoregional flaps were used to cover smaller
defects or to preserve vita sexualis in young women with posterior vulvar tumors.
Results: The preparation and insertion of a distant VRAM flap was a reliable procedure to
close large defects in the mons pubic area and large defects in the vulvar area; the
gluteal fold flap was used to reconstruct the vulva laterally and dorsally; vaginal
and periurethral defects were reconstructed ideally with Singapore flaps. Myocutaneous
advancement flaps can be used to reconstruct the posterior fourchette to prevent vaginal
stenosis. Individualized planning of the reconstructive procedure is key. Severe complications
were rare in our series. Conclusion: We conclude that individualized plastic reconstructive procedures are a safe treatment
option, when performed by experienced surgical gynecologists who are familiar with
plastic reconstructive techniques, to preserve sexual function or close large vulvar
defects after resection for recurrent vulvar carcinoma.
Schlüsselwörter
Vulvakarzinom - Rezidiv - plastisch‐rekonstruktive Verfahren - lokoregionäre Lappen
- distante Lappen
Key words
vulvar cancer - recurrent disease - plastic reconstructive procedures - regional flap
- distant flaps
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Prof. Dr. med. Monika Hampl
Universitätsfrauenklinik Düsseldorf
Moorenstraße 5
40225 Düsseldorf
eMail: hampl@med.uni-duesseldorf.de
