Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis

Devulapalli, Chris; Wei, Anne Tong Jia; Dibiagio, Jennifer R.; Baez, Marcelo L.; Baltodano, Pablo A.; Seal, Stella; Sacks, Justin M.; Cooney, Carisa M.; Rosson, Gedge D.

doi:10.1097/prs.0000000000002107

Cited by 167 publications

(173 citation statements)

References 41 publications

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“…In our series, there was an overall 30‐day healed perineal wound rate of 72% and low complication rates of the reconstructed site (28%) and the donor site (20%). These rates are lower than a recent systematic review that demonstrated perineal and donor site complication rates of 52.9% for gracilis flaps . This may highlight the importance of a familiar combined multidisciplinary approach, as there is a technical learning curve owing to the complexity of these cases.…”

Section: Discussionmentioning

confidence: 99%

Single centre experience of bilateral gracilis flap perineal reconstruction following extra‐levator abdominoperineal excision

et al. 2019

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Aim A variety of tissue flaps have been described for the closure of perineal wounds following abdominoperineal excision of the rectum (APE) or exenteration for locally advanced/recurrent rectal cancer and salvage surgery for anal cancer. The aim of this study was to demonstrate the utility of the bilateral pedicled gracilis muscle flaps (BPGMFs) as a reconstruction option in these patients. This is of particular benefit when using a laparoscopic approach for the abdominal component of the operation, avoiding disruption of the abdominal wall and risk of herniation with other reconstruction options, e.g. vertical rectus abdominis myocutaneous flaps. Method This is a retrospective single centre case series of patients who underwent reconstruction of perineal defects using BPGMFs using a novel weave technique, from January 2008 to August 2017. Results There were 25 patients (16 female), with a median follow‐up of 19 months (3–102). The indications for BPGMFs were cancer resection (21) and perineal hernia (4). The median length of stay was 14 days (6–60). All‐cause mortality was 36% within the follow‐up period. A healed perineal wound was achieved in 72% of patients within 30 days (84% of patients received neoadjuvant chemoradiotherapy). The overall donor site complication rate was 20% (including infection, dehiscence, numbness, haematoma and seroma) and 28% for the perineal site (including infection, dehiscence and prolapse). Conclusions BPGMFs provide an important option for reconstruction of the perineum particularly with a minimally invasive approach or with two stomas.

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Section: Discussionmentioning

confidence: 99%

Single centre experience of bilateral gracilis flap perineal reconstruction following extra‐levator abdominoperineal excision

et al. 2019

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“…The pelvic dead space can result in abscess formation, intestinal occlusion, or fistulization due to strong adhesions that form on the pelvic walls. These complications can be prevented by using techniques such as a muscle flap, silicone prosthesis, or the omentum to fill this space …”

Section: Resultsmentioning

confidence: 99%

“…When the procedure's morbidity remains low, it is recommended to use the best performing pedicled myoperitoneal or myocutaneous flaps …”

Section: Resultsmentioning

confidence: 99%

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

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“…объединен опыт 10 исследований с общим числом 566 пациентов по использованию кожно-мышечных лоскутов (доста-точно репрезентативными исследованиями были со-чтены только работы по использованию VRAM-лоскута и m. gracilis). Авторы отметили достоверное снижение частоты тяжелых осложнений со стороны промежностной раны при использовании пластики: отношение рисков 3,64; 95 % доверительный интервал 1,43-7,79; p = 0,005 [44].…”

Section: заключениеunclassified

Methods of reconstruction of perineal wounds after abdominoperineal resection. Literature review

Гордеев¹,

Иванов²,

Кузьмичев³

et al. 2017

Onkol. koloproktol.

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Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis

Abstract: Therapeutic, II.

Cited by 167 publications

References 41 publications

Single centre experience of bilateral gracilis flap perineal reconstruction following extra‐levator abdominoperineal excision

Single centre experience of bilateral gracilis flap perineal reconstruction following extra‐levator abdominoperineal excision

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Methods of reconstruction of perineal wounds after abdominoperineal resection. Literature review

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