Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer

Abstract

BackgroundAbdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel gluteal turnover flap (GT-flap) without donor site scar for perineal closure after APR.MethodsConsecutive patients who underwent APR for primary or recurrent rectal cancer were included in a prospective non-randomised pilot study in two academic centres. Perineal reconstruction consisted of a unilateral subcutaneous GT-flap, followed by midline closure. Feasibility was defined as uncomplicated perineal wound healing at 30 days in at least five patients, and a maximum of two flap failures.ResultsOut of 17 potentially eligible patients, 10 patients underwent APR with GT-flap-assisted perineal wound closure. Seven patients had pre-operative radiotherapy. Median-added theatre time was 38 min (range 35–44 min). Two patients developed a superficial perineal wound dehiscence, most likely because of the excessive width of the skin island. Two other patients developed purulent discharge and excessive serosanguinous discharge, respectively, resulting in four complicated wounds at 30 days. No flap failure occurred, and no radiological or surgical reinterventions were performed. Median length of hospital stay was 10 days (IQR 8–12 days).ConclusionsThe GT-flap for routine perineal wound closure after APR seems feasible with limited additional theatre time, but success seems to depend on correct planning of the width of the flap. The potential for reducing perineal morbidity should be evaluated in a randomised controlled trial.Electronic supplementary materialThe online version of this article (10.1007/s10151-019-02055-1) contains supplementary material, which is available to authorized users.

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

“…The specimen is extracted trough the perineal wound. The perineal defect is then closed primarily, with a subcutaneous gluteal turnover flap [33] or by aid of (biological) mesh upon individual basis.…”

“…A minimally invasive transperineal approach to the perineal part of an APE has potential advantages over the standard technique, although data on this new technique are limited [33]. This multicenter series describes the combined initial experience of five expert centers in four countries with a transperineal minimally invasive APE technique (TpAPE) for locally advanced low rectal cancer.…”

Perineal Turn over Perforator Flap: A Novel Surgical Technique for Combined Perineal and Posterior Vaginal Wall Reconstruction

“…An extended version of the PTO flap herein presented offers a quick (operating time of 60 min), simple and safe solution for composite post-ELAPE perineal and PWW defects, adding to its versatility 12 , 13 . A further case series using a minimally modified similar technique has since been reported highlighting the benefits of this technique 14 . Despite the description of a single case, we look forward to building experience and data on this technique for this composite defect to confirm its various advantages.…”

Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

“…In the cohort with FA, change in management due to FA occurred in 28 (78%) out of 36 cases and led to an additional resection of a median of 37 g (IQR 17-100) of omentum. In one case, additional resection resulted in insufficient bulk of omentum for pelvic filling, and therefore a gluteal turnover flap was created for additional filling and perineal closure [10,11]. Use of FA and subsequent management took a median of 7 min (IQR 3-13).…”