Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology

• Many clinical scenarios exist where commonly used reconstructive options are suboptimal or unavailable.
• Alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are reviewed.
• Patient selection, indications, surgical technique, clinical uses and outcomes for these alternative reconstructive options are discussed.

ObjectivesThe objective of this review is to discuss alternatives to commonly used methods of soft tissue reconstruction in patients with gynecologic malignancies, and in particular alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps.MethodsA review of the literature was performed on soft tissue reconstruction in patients with gynecologic malignancies.ResultsSoft tissue reconstruction is often necessary to achieve successful wound healing, minimize complications, and to restore anatomic form and function. Commonly used methods such as skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are effective, but many scenarios exist where they may be suboptimal or unavailable for use. Situations faced by the gynecologic oncologist where this may be the case include patients in whom prior treatments and/or tumor involvement have affected the vascular supply and tissues of commonly used options, those with disease recurrence who have previously undergone tumor extirpation and reconstruction, and patients undergoing radical surgery where commonly used options alone are inadequate. Under these circumstances, there are several alternative options, and an understanding of the full spectrum of reconstructive techniques is essential.ConclusionsMany clinical scenarios exist where commonly used options for soft tissue reconstruction are suboptimal or unavailable. Current evidence supports use of alternative methods of reconstruction in these situations. However, further larger scale and comparative studies are needed to refine surgical decision-making.