利用深下腹動脈穿通枝皮瓣修補經放射治療後之複雜性膀胱陰道瘻管並同時實施膀胱擴大成形術—病例報告與文獻回顧

謝易耕¹、吳至偉^2,3、陳建綸^1,3

林口長庚紀念醫院, 外科部, 泌尿科¹; 林口長庚紀念醫院, 外科部, 重建整形外科²; 長庚大學 醫學院³

Repair of a complicated radiated vesicovaginal fistula and concomitant bladder augmentation with a deep inferior epigastric artery perforator (DIEP) flap – A case report and literature review

Yi-Keng Hsieh¹, Chih-Wei Wu ^2,3 and Chien-Lun Chen ^1,3

Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan¹; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan²; Chang Gung University Medical College, Taoyuan, Taiwan³

               Urinary leakage caused by vesicovaginal fistula (VVF) is a significant concern for women worldwide. VVFs can be categorized as simple fistulas measuring less than 0.5 cm or complex fistulas greater than 0.5 cm or those that have failed prior repairs. Radiated vesicovaginal fistula (RVF) are often classed as complex VVFs that require flaps with a blood supply for proper healing.

               In this report, we present the case of a cervical cancer patient who suffered from RVF and a contracted bladder. The patient underwent a salvage operation involving a deep inferior epigastric artery perforator (DIEP) flap repair along with bladder augmentation. Satisfactory surgical outcomes were achieved, with no incontinence or fistula observed on cystography during the five-month follow-up. The bladder capacity was adequate and the patient’s quality of life has dramatically improved.

               While the DIEP flap is frequently utilized in breast reconstruction after mastectomy, to the best of our knowledge, this is the first report of using a DIEP flap for simultaneous RVF repair and bladder augmentation. In contrast to the rectus abdominus myofascial (RAM) interposition flap, the DIEP flap does not compromise the strength of the abdominal wall. Advantages of flap repair over to bowel repair for bladder augmentation may include a lower risk of bowel-related complications, no long-term surveillance for mucus production, and a faster recovery time.