Gluteal turnover flap for perineal reconstruction following abdominoperineal resection for rectal cancer – a video vignette

Blok, Robin D.; Kaçmaz, Enes; Hompes, Roel; Lapid, Oren; Bemelman, W. A.; Tanis, Pieter J.

doi:10.1111/codi.14715

Cited by 7 publications

(6 citation statements)

References 5 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An additional transposition flap was performed in 5 of 18 patients (28%) in the biological mesh group and in 3 of 16 patients (19%) in the synthetic mesh group (P = 0.693). The transposition flaps used to reconstruct the perineum consisted of a VY fasciocutaneous gluteal flap (n = 3), an inferior and superior gluteal artery perforator flap (n = 1 each), a gracilis flap (n = 1) and a gluteal turnover flap (n = 2) [18][19][20]. The median operative time was comparable between both mesh groups (P = 0.142).…”

Section: Reconstruction Detailsmentioning

confidence: 99%

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

et al. 2020

Self Cite

View full text Add to dashboard Cite

Aim There is little evidence concerning the optimal surgical technique for the repair of perineal hernia. This study aimed to report on the evolution of a technique for repair of perineal hernia by analysing the experience in a tertiary referral centre. Method This was a retrospective review of consecutive patients who underwent perineal hernia repair after abdominoperineal excision in a tertiary referral centre. The main study end‐points were rate of recurrent perineal hernia, perineal wound complications and related re‐intervention. Results Thirty‐four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent perineal hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re‐repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent hernias were observed in this subgroup (P = 0.030). No mesh‐related small bowel complications occurred. Conclusion Recurrence rates after perineal hernia repair following abdominoperineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

show abstract

Section: Reconstruction Detailsmentioning

confidence: 99%

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Considering the clinical implications, there is a need for alternative closure techniques, mainly because a biomesh fails to improve perineal wound healing. Small gluteal transposition flaps that eliminate the perineal dead space are promising new interventions, [44][45][46] but more high-quality data is required. We have therefore launched a second international multicenter randomized controlled trial (BIOPEX-2), 47 comparing a gluteal turnover flap with primary closure of the perineal wound, the latter being still considered standard of care by our study group.…”

Section: Discussionmentioning

confidence: 99%

Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study)

et al. 2021

View full text Add to dashboard Cite

Objective: To determine long-term outcomes of a randomized trial (BIO-PEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia. Summary Background Data: BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing). Methods: This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n ¼ 50; 2 dropouts) or primary perineal closure (n ¼ 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic.Results: Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0-30) after biological mesh closure versus 30% (95% CI, 10-49) after primary closure (P ¼ 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P ¼ 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P ¼ 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome. Conclusions: Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.

show abstract

“…Postoperatively, patients did not have to be on a pressure relief mattress and were allowed to sit and walk from day 1 post-operative. Pictures of the procedure as well as a video vignette have previously been published [ 6 , 8 ].…”

Section: Methodsmentioning

confidence: 99%

A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Methods Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Results Twenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). Conclusions The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.

show abstract

Gluteal turnover flap for perineal reconstruction following abdominoperineal resection for rectal cancer – a video vignette

Cited by 7 publications

References 5 publications

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study)

A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer

Contact Info

Product

Resources

About