Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision

Abstract

Data from the controlled studies support the use of myocutaneous flaps for single-stage reconstruction after APE in the presence of chemoradiotherapy. Ultimately, the choice of flap depends on the goals of reconstruction, size of the defect and the availability of donor tissue. The implications of an expanding role for radiotherapy in the treatment of low rectal cancer and radical dissection to achieve negative circumferential margins, necessitate close co-operation between colorectal and reconstructive surgeons to achieve APE with reduced wound morbidity.

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

“…Myocutaneous flaps are one possible solution for reduction of perineal wound related complications, yet they add significantly to the duration of the procedure and all carry the risk of longer bed rest, flap-related complications and donor site morbidity. 5,31 Our study adds to the work of other groups on biologic grafts for repair of large perineal wounds 32,33 and indicates that good outcomes can be obtained without the addition of a flap procedure.…”

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

“…It has been shown that a non-healing wound can complicate an APR in up to 51% of patients. 9 Bullard et al reported a major wound complication rate of 35% out of 160 APR patients. 10 These results have meant that advancements in surgical technique have been necessary to improve wound healing.…”

“…Nisar and Scott reported 10 fascial dehiscences in 385 patients. 9 This gave a dehiscence rate of 2%. Others have reported rates of between 0% and 11%.…”

“…A series of 49 patients who had primary reconstruction with a RAM flap has been published, 9,12 with major wound breakdown occurring in only one patient. In the most recent paper published, this figure was 17% for all types of myocutaneous flaps.…”

Application of Rotational Computed Tomography Angiography and 3D Modeling in Planning One-Stage Reconstruction of the Pelvic Floor after Evisceration of the Pelvic Organs

“…Skin-muscle flap of the gluteus maximus muscle, skin-muscle-fascia flap of the thin thigh muscle (gracilis muscle) and transfer vertical skin-muscle flap of the abdominal rectus muscle are used most commonly [3,[5][6][7]. Application of the gracilis muscle as a basis of the skin-muscle-fascia transfer flaps with axial blood supply is favored by an easy access for harvesting, the possibility of bilateral plasty, if necessary, and minimal early and late complications at the site of the donor area [4].…”