An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer

Shukla, H. S.; Tewari, Mallika

doi:10.1002/jso.21605

Cited by 24 publications

(13 citation statements)

References 56 publications

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“…Although CTA has a clear role in demonstrating the caliber and patency of perforators for planning free tissue transfer, its value in pedicled flaps is less widely described, as has the use of muscle‐sparing flaps in this setting 9. The present case shows the value of CTA in planning a muscle‐sparing and/or fascia‐sparing pedicled VRAM, or indeed a deep inferior epigastric artery perforator (DIEP) flap if warranted, in the reconstruction of perineal defects.…”

Section: Discussionmentioning

confidence: 86%

A unique deep inferior epigastric artery perforator and implications for a muscle and fascia sparing vertical rectus abdominis myocutaneous flap: A case report

et al. 2011

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Despite the sacrifice of rectus abdominis muscle, the vertical rectus abdominis musculocutaneous (VRAM) flap is still a preferred option for perineal reconstruction. This journal has previously reported on the utility of preoperative computed tomographic angiography (CTA) in this setting to identify cases that are both suitable and unsuitable for rectus abdominis flaps after previous surgery. We report a case which highlights a unique example of the benefits of such imaging, with the largest deep inferior epigastric artery (DIEA) perforator described to date identified on imaging, and used to potentiate a donor-site sparing procedure. The use of this dominant perforator was able to limit donor site harvest to only a small cuff of anterior rectus sheath and a small segment of rectus abdominis, potentiating a muscle-sparing and fascia-sparing VRAM flap for perineal reconstruction. As such, preoperative CTA was found to be a useful tool in identifying a unique anatomical variant in the largest DIEA perforator described to date, and was used to potentiate a muscle-sparing and fascia-sparing VRAM flap for perineal reconstruction.

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Section: Discussionmentioning

confidence: 86%

A unique deep inferior epigastric artery perforator and implications for a muscle and fascia sparing vertical rectus abdominis myocutaneous flap: A case report

et al. 2011

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“…In Japan, the SSI occurrence rate was reported to be 25-47% [21,22]. The large amount of dead space in the pelvis following RA, closure under tension and the closure of a wound in an area that has a high bacterial count [23,24] may be causes for the rate of SSI. In this series, PWC occurred in 33.3% of all patients who underwent RA for primary anorectal carcinoma.…”

Section: Discussionmentioning

confidence: 99%

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

et al. 2020

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Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare shortand long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods:We retrospectively analyzed the short-and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group).Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 min, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

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“…In Japan, the SSI occurrence rate was reported to be 25-47% [8,9]. The large amount of dead space in the pelvis following RA, closure under tension and the closure of a wound in an area that has a high bacterial count [10,11] may be causes for the rate of SSI. In this series, PWC occurred in 31.9% of all patients who underwent RA for primary anorectal carcinoma.…”

Section: Discussionmentioning

confidence: 99%

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

Funahashi

Goto

Kaneko

et al. 2019

Preprint

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Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods: We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group). Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 minutes, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

show abstract

An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer

Cited by 24 publications

References 56 publications

A unique deep inferior epigastric artery perforator and implications for a muscle and fascia sparing vertical rectus abdominis myocutaneous flap: A case report

A unique deep inferior epigastric artery perforator and implications for a muscle and fascia sparing vertical rectus abdominis myocutaneous flap: A case report

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

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