Pedicled myocutaneous flap transfer for pelvic floor reconstruction to prevent empty pelvis syndrome following total pelvic exenteration

doi:10.3877/cma.j.issn.1674-392X.2026.05.001

Abstract

Abstract:

Objective

To evaluate the clinical efficacy of pedicled myocutaneous flap transfer for pelvic floor reconstruction in the prevention and management of empty pelvis syndrome (EPS) following total pelvic exenteration (TPE).

Methods

This retrospective study used a descriptive case-series design. Clinical data were collected from 10 patients who underwent TPE combined with pelvic floor reconstruction using pedicled myocutaneous flaps at the Department of General Surgery, Jiangyin People's Hospital, between December 2023 and July 2026. The primary outcome was the occurrence of EPS-related symptoms following pelvic floor reconstruction. Secondary outcomes included flap survival, pelvic floor wound healing, perioperative complications, and, in patients undergoing staged procedures, the duration of preoperative negative-pressure wound therapy and control of wound infection.

Results

All 10 myocutaneous flaps survived. The median postoperative follow-up was 9.0 months (interquartile range, 1.8 to 22.5 months), during which one patient died of tumor recurrence. No EPS-related symptoms were observed during follow-up, and satisfactory filling of the pelvic dead space was achieved. Primary healing of the pelvic floor surgical wounds was achieved in 3 patients, while delayed healing occurred in 7 patients. Of these 7 patients, 2 developed purulent wound infections that resolved with dressing changes. At the donor sites, primary wound healing was achieved in 8 patients, while delayed healing occurred in 2 patients. No donor-site abscesses or hematomas were observed. Among the 2 patients who underwent vertical rectus abdominis flap transfer, neither developed an abdominal wall hernia, although 1 experienced delayed healing of the abdominal incision.

Conclusion

Pedicled myocutaneous flap transfer appears to be a feasible and potentially safe option for pelvic floor reconstruction following TPE. This technique can provide satisfactory filling of the pelvic dead space and may help prevent EPS. However, further studies are needed to confirm its effectiveness in reducing the risk of EPS.

Key words: Total pelvic exenteration, Empty pelvis syndrome, Pedicled myocutaneous flap, Pelvic floor reconstruction, Flap transfer

Weidong Zhong, Gen Hu, Jinchun Liu, Liqiang Dai, Zhen Wang, Lingxiao Pu, Liangdong Geng, Guoyi Shao. Pedicled myocutaneous flap transfer for pelvic floor reconstruction to prevent empty pelvis syndrome following total pelvic exenteration[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(05): 481-486.

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Figures/Tables 5

References 27

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