Options for pelvic floor reconstruction after extralevator abdomin-operineal resection (APR): Myocutaneous flap or porcine dermal collagen implant

Cardone, E.; Rega, Daniela; Scala, D.; Tammaro, Pasquale; Sassaroli, C.; Mori, Stefano; Montesarchio, Luca; Pace, Ugo; Delrio, Paolo

doi:10.1016/j.ejso.2012.07.018

Cited by 1 publication

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“…[1][2][3][4] Fistulae, chronic abscesses, irradiated skin, and constant pressure during seating are some of many challenges to overcome. [5][6][7] For these reasons, perineal reconstruction requires voluminous, stable and reliable tissue. Literature reports flap reconstruction in abdominoperineal resection (APR) ranging from 7% to 20%, 8,9 with primary closure showing a significant increase of perineal complications compared to flap closure.…”

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confidence: 99%

Outcomes of the Composite Anterolateral Thigh Flap for Perineal Reconstruction After Postoncological Abdominoperineal Resection

Rossi

Martineau

Garcı́a-Dorado

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The vertical rectus abdominis flap is considered the gold standard in perineal reconstruction after oncological abdominoperineal resection; however, it has a nonnegligible donor site morbidity. The anterolateral thigh flap offers reliable soft tissue coverage. OBJECTIVE:The aim was to analyze long-term outcomes of composite anterolateral thigh-vastus lateralis flaps in oncological abdominoperineal resections. DESIGN:We conducted a retrospective cohort analysis of a prospectively maintained database. SETTINGS:This study was conducted in the Lausanne University Hospital. Annually, approximately 10 oncological abdomioperineal resections are performed. Literature reports 7% to 20% of patients undergoing abdominoperineal resection require flap reconstruction; in our institution, approximately 2 patients with large defects after abdominoperineal resections required reconstruction.PATIENTS: Twenty-nine pedicled anterolateral thighvastus lateralis flaps in 27 consecutive patients (mean age 63 years +/-11.2, 23 with radiochemotherapy) after abdominoperineal resection to cover large defects (median 190 cm 2 , 48-600 cm 2 ) were analyzed. INTERVENTION:Pedicled composite anterolateral thighvastus lateralis flaps were performed after oncological abdominoperineal resection. MAIN OUTCOME MEASURES:Descriptive statistical analysis was conducted. Short-and long-term outcomes were analyzed, univariate and multivariate analyses were performed. Median follow-up was 16 months (12-48 months).RESULTS: Flap-related postoperative complications occurred in 16 flaps; flap-survival was 100%. Multivariate logistic analysis identified initial defect size as predictive for complications. Patients with larger defects (≥ 190 cm 2 ) had higher complication rates (p = 0.006). Long-term analysis revealed 3 chronic fistulae, 2 tumor recurrences, 1 flap dysesthesia, and one perineal acne inversa.LIMITATIONS: Limitations include retrospective analysis, selection bias, and lacking a control group. Sample size limits statistical power. CONCLUSIONS:The pedicled anterolateral thighvastus lateralis flap offers reliable, stable tissue with low morbidity and good long-term outcomes. Complications compared favorably with current literature describing perineal reconstructions with rectus abdominis flaps. The composite anterolateral thigh flap is a valid alternative without the setback of abdominal donor site morbidity.

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