Application of omental flap in total vaginectomy for post-radiotherapy recurrent cervical cancer: a case report

Cervical squamous cell carcinoma (CSCC) is one of the most common gynecological malignancies, and radiotherapy is a key treatment modality. This paper reports a case of a 51-year-old female patient with cervical squamous cell carcinoma who developed a recurrence in the vaginal wall following radiotherapy. The patient was diagnosed with stage IIIb cervical squamous cell carcinoma four years ago and underwent radical radiotherapy at another hospital. Treatment consisted of pelvic external beam radiotherapy (50 Gy in 25 fractions) combined with two-dimensional brachytherapy (6 Gy in 4 fractions), yielding a total EQD2 of 82 Gy. The treatment proceeded without complications, and no significant radiation-induced damage was observed; however, the patient did not attend regular follow-up appointments after radiotherapy. During this follow-up, squamous cell carcinoma (keratinising type) of the vaginal wall was identified. Following a comprehensive evaluation that ruled out surgical contraindications, the patient underwent laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, and total vaginectomy combined with vaginal packing using a pedicled omental flap. Given the presence of radiotherapy-induced vaginal fibrosis, total vaginectomy carries a heightened risk of poor wound healing, as well as an increased risk of bladder and bowel injuries, which would be challenging to manage in a subsequent repair. To promote healing of the vaginal stump and prevent the occurrence of vesicovaginal and rectovaginal fistulas, the vaginal stump was packed with an omental flap during the procedure. The pedicled omentum flap has a rich blood supply and lymphatic drainage; when packed into the vaginal stump during surgery, it effectively promotes local tissue healing, forms a biological barrier to isolate the bladder from the rectum, and significantly reduces the incidence of fistula formation. A full abdominal and pelvic CT scan performed three months post-operatively revealed no significant abnormalities in the vaginal wall, providing preliminary confirmation of the procedure's safety and efficacy. Given that the clinical management of such patients remains challenging, this case offers a new technical reference for the diagnosis and treatment of similar cases, emphasising the importance of individualised, multidisciplinary, comprehensive treatment, and holds potential clinical value for improving the prognosis of these patients.