Perineal reconstruction following abdominoperineal resection: Comprehensive review of the literature

Copeland-Halperin, Libby R.; Stewart, Talia; Chen, Youdinghuan; Funderburk, Christopher D.; Freed, Gary L.

doi:10.1016/j.bjps.2020.08.090

Cited by 14 publications

(11 citation statements)

References 42 publications

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“…Selecting the optimal reconstruction can be challenging and dependent on numerous factors such as age, body habitus, functional status, surgical approach, surgical history, location of scars, previous radiation, extent of perineal defect, surgeon preference, among others. 7,9 Within the armamentarium of advanced closures techniques myocutaneous flaps are the preferred method utilized and have shown favorable results in recent systematic reviews and meta-analyses. 12,22,23 Generally, the myocutaneus flaps for the perineum can be subdivided into abdominal and thigh-based flaps.…”

Section: Discussionmentioning

confidence: 99%

“…8 To ameliorate this, various advanced closure techniques have been described including creation of abdominal, perineal, thigh myocutaneous, and pedicled omental flaps. 9 These can be used independently or with aid from a biologic mesh. 9 The current literature on this topic acknowledges closure from myocutaneous flap to have favorable results, particularly seen in single center studies.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus

Cataneo

Mathis

Faqihi

et al. 2023

The American Surgeon

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Background Perineal reconstruction following salvage APR’s for squamous cell carcinoma of the anus (SCCA) are scant with conflicting results from large and single center studies. We analyzed these techniques taking into account sociodemographic and oncologic variables. Methods This is a retrospective cohort study from 2016-2019 using a targeted ACS/NSQIP database stratified into primary closure (PC), abdominal myocutaneous (AM), lower extremity (LE), and omental pedicled (OP) flaps. We analyzed major and wound complications through univariate and multivariate regression analysis. Results A total of 766 patients were analyzed, 512 (67%) had PC, 196 (25%) AM, 36 (5%) OP and 22 (3%) LE. Rates of chemotherapy and radiation within 90 days were similar between the groups. Having 2 or more additional organs resected was more common for the AM group (AM 4.1%, PC 1.6%, OP 3.3%, LE 0%). Overall, major complication rate was 41% (n = 324). Primary closure had 35.0%, OP 47.2%, AM 52.6%, and LE 45.5%. Wound complication rate was highest in AM with 11.7%, followed by OP 8.3%, PC 5.9%, and LE 0%. The multivariate regression analysis demonstrated none of the closure techniques to be associated with increasing or decreasing the probability of having a major or wound complication. Morbidity probability was the sole predictor of major complication (OR 1.07, 95% CI 1.04-1.1) Conclusions Myocutaneous and omental flaps are associated with comparable wound and major complications when taking into account the baseline, oncologic and perioperative variables that drive the clinical decision making when selecting a perineal reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus

Cataneo

Mathis

Faqihi

et al. 2023

The American Surgeon

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“…Abdominal-based flaps, such as the VRAM, offer the advantages of tissue bulk, ease of dissection, reliable vascular pedicle, and provision of vascularised tissue from non-irradiated areas in patients who have had prior radiotherapy. Several studies have also demonstrated favourable perineal wound complication rates compared to primary closure and certain thigh-based flaps (PAP flap and gracilis flap) [12,19,23,24]. However, the need for a significant abdominal incision precludes the use of the VRAM flap in laparoscopic or robotic-assisted APE/ELAPE, both of which have become more favourable in recent years [14].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, with up to 90% of perineal resection in ELAPE being performed in the prone position [14], there is an additional requirement to turn the patient intraoperatively (60% of units preferring VRAM turned patients intraoperatively in our study). Other significant limitations of the VRAM flap include the risk of partial/total flap necrosis [12], significant donor site morbidity [25], and disruption of potential future stoma sites [24], the latter being an important consideration in younger patients who have a higher likelihood of developing parastomal hernia and need for stoma re-siting [26]. The use of the VRAM flap is limited in high body mass index patients, where flap raise and inset can be challenging due to the significant soft-tissue bulk.…”

Section: Discussionmentioning

confidence: 99%

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A National Survey on Perineal Reconstruction Following Standard and Extralevator Abdominoperineal Excision: Current Practices and Trends in the UK

Shah¹,

Kamble²,

Herieka³

et al. 2022

Cureus

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BackgroundChallenging perineal defects resulting from extralevator (ELAPE) and standard abdominoperineal excision (APE) have given rise to an emerging multidisciplinary approach between colorectal and plastic surgeons. At present, there is a relative paucity of evidence on best practice. This study sought to assess current national practice concerning perineal reconstruction following APE/ELAPE in the United Kingdom (UK) and to determine the factors involved in reconstruction choice. MethodologyAn anonymised survey was circulated to consultant plastic surgeons at all 48 UK centres performing perineal reconstruction following APE/ELAPE. Responses were collected between October 2021 and April 2022. ResultsComplete responses were received from 24 units nationally. All units had a dedicated APE/ELAPE service. Overall, 70% adopted a standardised reconstructive approach, the most common being the inferior gluteal artery perforator flap (n = 11). Significant variation was identified in the reconstructive technique. Similar differences were observed in the perceived importance of surgical factors guiding the reconstructive decision-making process, the top priorities being the size of the defect and previous radiotherapy. ConclusionsThe variability of responses suggests a lack of national consensus on optimal reconstruction following APE/ELAPE, despite the majority of centres employing a standardised approach to reconstruction. Our study highlights important surgical decision-making factors and provides valuable insight to aid in developing national collaborative evidence-based guidelines on best practice.

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A V–Y fasciocutaneous flap for perineal reconstruction following abdominoperineal resection: quicker and better than a myocutaneous gluteal flap?

2023

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Background Abdominoperineal resection in patients with anorectal malignancies may require flap reconstruction for large perineal defects as an adjunct to the oncologic surgery. Perineal reconstruction should be timely, safe, and yield good long-term functional results. There is no agreement on the ideal approach. Methods We performed a retrospective observational cohort study to compare clinical outcomes and post-operative complications between a musculocutaneous gluteal flap and a fasciocutaneous V–Y flap for perineal reconstruction. We included all patients who underwent abdominoperineal resection at Karolinska University Hospital between 2016 and 2019. Patient demographics and comorbidities, as well as treatment data, post-operative complications, and follow-up data, were collected from medical records. Results A total of 44 patients were included with a mean age of 65 years where 73% were men. Reconstruction was made with a musculocutaneous gluteal flap in 19 patients (43%) and with a fasciocutaneous V–Y flap in 25 patients (57%). Flap-related post-operative complications occurred in 39% of the patients and the incidence did not differ between the groups (p = 0.831). Neither operative time, time to ambulant mobility, time to drain removal, nor time to epidural removal differed between the groups (p > 0.05). Four patients in the gluteal flap group and one patient in the V–Y flap group presented with long-term complications. Conclusions Post-operative complications are common after perineal reconstruction following abdominoperineal resection regardless of reconstructive approach. Our study confirms that both a fasciocutaneous and a musculocutaneous flap are acceptable options for perineal reconstruction. Level of evidence: Level III, risk/prognostic study.

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Perineal reconstruction following abdominoperineal resection: Comprehensive review of the literature

Cited by 14 publications

References 42 publications

Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus

Comparison of Perineal Closure Techniques after Abdominoperineal Resections for Carcinoma of the Anus

A National Survey on Perineal Reconstruction Following Standard and Extralevator Abdominoperineal Excision: Current Practices and Trends in the UK

A V–Y fasciocutaneous flap for perineal reconstruction following abdominoperineal resection: quicker and better than a myocutaneous gluteal flap?

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