Factors associated with the use of vertical rectus abdominus myocutaneous flap reconstruction following abdominoperineal resection for anorectal cancer

Abstract

Background and Objectives Following abdominoperineal resection (APR), primary closure of the perineal defect is often possible. Some patients, however, require flap reconstruction. Identifying these patients preoperatively is critical to facilitate comprehensive patient counseling and optimize surgical efficacy. Methods A retrospective review of patients undergoing APR over a 10‐year period was performed to identify predictive factors for patients requiring reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap as opposed to primary closure. Student's t and Fisher's exact tests were utilized for statistical analysis. Results A total of 158 patients underwent APR, 29 of whom (18%) required a VRAM flap. A higher average skin resection area was seen among those requiring flap reconstruction (P < .0001). Flap reconstruction was also associated with current smoking status (P = .0197), anal tumor location (P < .0001), and neoadjuvant radiation (P = .0457). Although not statistically significant, average tumor diameter was larger in the VRAM flap group compared with the primary closure group. Conclusions While the appropriate method of closure for those undergoing APR should be considered on an individual case basis, patients who smoke, have a tumor located at the anus, or require large skin resection are more likely to need flap reconstruction.

Vertical Rectus Abdominis Muscle Flap for Repair of the Anterior Chest Wall Defect

“…В противовес этому, независимо от конституции и физического развития пациента, прямая мышца живота развита всегда удовлетворительно, что является хорошим прогностическим фактором для использования ее в пластических целях. На сегодняшний день лоскут пмЖ активно применяется в пластической хирургии молочной железы в виде свободного поперечного лоскута [12,13], при дефектах грудной стенки после радикальных онкологических вмешательств [1,4], в хирургии промежности при ректальном раке [14,15].…”

Discussion: System-Level Determinants of Access to Flap Reconstruction after Abdominoperineal Resection

“…3,4 Indications for flap reconstruction have included a history of tobacco use, anal cancer, or neoadjuvant radiotherapy and a larger expected surface area of perineal resection. 5 Even in scenarios that do not require large perineal skin resections, replacing (often irradiated) dead space with well-vascularized autologous tissue yields superior outcomes. Even very large defects can be successfully reconstructed using extended vertical rectus abdominis myocutaneous flaps or supplementing vertical rectus abdominis myocutaneous flaps with greater omentum flaps.…”