Perineal Repair After Abdominoperineal Excision With Rectus Abdominis Myocutaneous Flap

Abstract

Background: Abdominoperineal excision of the rectum (APR) remains the only potential curative treatment for very low rectal adenocarcinoma and squamous cell carcinoma of the anus. Yet, it implies a significant perineal exenteration and has set the attention on the perineal reconstruction. Aim: To present technique used in one case of APR for anal cancer, with resection of the vaginal posterior wall with large perineal defect which has called for the necessity of a flap for reconstruction Method: To cover the large perineal defect and reconstruct the posterior vaginal wall was perform a standardized and reproducible surgical technique using oblique rectus abdominis myocutaneous (ORAM) flap. The overlying skin of this flap is thick and well vascularized by both superficial branches and perforators of the superior epigastric artery and the deep inferior epigastric artery which serves as the vascular pedicle for the ORAM flap. Results: This procedure was applied in a 65-year-old woman with recurrent squamous cell carcinoma of the anus infiltrating the posterior wall of the vagina. Was performed an APR with en-bloc resection of the vaginal posterior wall in order to achieve tumor-free margins. Postoperative course was uneventful and she was discharged home at postoperative day 9. Final pathological report confirmed the oncological adequacy of the procedure (R0) and showed a rypT4N0 lesion. Conclusion: Flap reconstruction is an effective way to cover the perineal wound reducing both perineal complication rate and wound healing delay. The ORAM is particularly interesting for female whose tumors require resection and subsequent reconstruction of the posterior wall of the vagina.

A systematic review of female sexual function after surgery for locally advanced or recurrent colorectal cancer – first step to filling the knowledge gap

“…Of the 431 female patients involved, sexual data for 262 women (60.8%) were reported. Three studies contained both baseline and postoperative records of sexual activity [11, 15, 16]. Of the 153 women who were sexually active before the surgery, only 64 (41.8%) were postoperatively, with a lower rate of sexual activity in each of these studies (see Table 4).…”

“…Reconstructive procedures, such as vaginal reconstruction, form an important part of radical pelvic surgery [10]. Available reconstructive options include the anterolateral thigh flap (ALT), deep inferior epigastric perforator flap (DIEP), random fasciocutaneous flap, gracilis flap, inferior gluteal artery perforator flap (IGAP), myocutaneous flap, vertical rectus abdominis musculocutaneous flap (VRAM), oblique rectus abdominis musculocutaneous flap (ORAM), internal pudendal artery perforator flap (IPAP), perineal turnover perforator flap (PTO) or the use of skin grafts [11][12][13][14][15][16][17][18]. The choice of reconstruction depends on the patient's specific characteristics and preferences [19].…”