RESUMEN
When high-dose radiotherapy for carcinoma of the rectum, cervix, vagina or vulva fails and subsequent surgical excision by extended abdominoperineal resection or exenteration is performed, healing is often greatly delayed, for many months, and a scarred, deformed perineum results. The introduction of myocutaneous flaps opened up a new field for reconstruction of defects in a number of areas. The authors used a gracilis myocutaneous flap in 15 patients for primary reconstruction following surgical resection for failed radiotherapy of a primary carcinoma (of the rectum in 6, the cervix in 7 and the vulva in 2) and as a secondary procedure in 2 patients, 1 with an unhealed perineum 4 months after irradiation and extended abdominal resection for carcinoma of the rectum, and the other with extensive perineal necrosis following radiotherapy and chemotherapy. The operative technique, which is relatively simple, is described and illustrated. Since all patients had received radiotherapy, the myocutaneous flap was used primarily and successfully to reduce morbidity and healing time. However, even without radiotherapy, the deformity following exenteration is unacceptable and reconstruction by the method described should probably be planned as part of this operation. Not only can primary healing be expected, but the neovagina has a relatively normal appearance with satisfactory sensation and function.
Asunto(s)
Perineo/cirugía , Traumatismos por Radiación/cirugía , Colgajos Quirúrgicos , Abdomen , Femenino , Neoplasias de los Genitales Femeninos/radioterapia , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Métodos , Complicaciones Posoperatorias , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugíaRESUMEN
Acute rupture of a renal artery aneurysm is more likely to occur during pregnancy and when it does there is an associated high mortality for the mother and child. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. When a renal artery aneurysm is discovered in a woman of childbearing age surgical treatment, preferably primary repair, is indicated to prevent subsequent rupture during pregnancy. We report on a mother and child who survived acute rupture of a renal artery aneurysm following treatment by primary repair.
