Rectal cancer with invasion of adjacent pelvic organs is uncommon and poses significant operative challenges. Multimodal treatment combining neoadjuvant therapy and precise surgical technique is often required to achieve negative margins while preserving function.
We present a video of an 80-year-old female with low rectal adenocarcinoma (ypT4bN0M0) invading the posterior vaginal wall following chemoradiotherapy. A laparoscopic abdominoperineal resection with en bloc partial vaginectomy was performed, followed by reconstruction using a left gracilis myocutaneous flap. The minimally invasive approach provided excellent pelvic exposure and facilitated accurate dissection despite post-radiation fibrosis.
The patient had an uneventful postoperative recovery and was discharged on postoperative day 14 with no complications. Pathology confirmed R0 resection with no nodal involvement. At 6-month follow-up, the patient remained disease-free with satisfactory functional recovery.
This case demonstrates that, in selected patients and experienced centers, laparoscopic APR combined with reconstructive techniques offers a safe and effective option for locally advanced rectal cancer invading the vagina.
A step-by-step guide to performing a laterally-based bilobed transposition flap for nasal tip reconstruction.
The surgical management of rectovaginal fistulas remains difficult, as they tend to be recurrent and vary widely in location and complexity. We present a case of a 63-year-old woman with a low-lying rectovaginal fistula who initially underwent chemoradiation and a Low Anterior Resection for a low-lying rectal cancer. Her course was uneventful until two years post-operatively, at which time her anastomotic staple line became stenotic with associated bleeding. This was initially addressed by Gastroenterology who executed a dilation and achieved hemostasis with Argon Plasma Coagulation. This remedied the stenosis, however, it was complicated by the formation of a rectovaginal fistula. Due to the low-lying location and its presence in an irradiated field, a transvaginal approach with an interposed gracilis flap was elected for repair.
The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.
This video highlights the surgical nuances of rectus abdominis myocutaneous free flap harvest.
This procedure depicts the microvascular anastomosis between the free anterolateral thigh (ALT) flap and the superficial temporal artery (STA) and superficial temporal vein (STV).
This procedure demonstrates the inset of the anterolateral thigh (ALT) flap into a large composite wound after oncologic resection.
This procedure depicts the harvest of the anterolateral thigh flap to be utilized in the reconstruction of a post-extirpative scalp defect.
Myelomeningocele is the most common form of neural tube defect, developing after the 4th week of gestation. Although diagnosed prenatally, many patients did not have a chance to be treated before birth. The best approach in these situation is to perform surgical treatment at time zero. A multidisciplinary team must be prepared to perform dural repair and soft tissue coverage. This video illustrates our approach for soft tissue reconstruction using rhomboid fasciocutaneous flaps with maximal preservation of perforator vessels.
Contributors
Dov Charles Goldenberg, MD Phd, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Vania Kharmandayan, MD, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
Tatiana Moura, MD, MSc, Division of Plastic Surgery, Hospital das Clinicas, University of Sao Paulo Medical School
