Reconstruction of perineal defects

Mughal, Maleeha; Rj, Baker; Muneer, Asıf; Mosahebi, Afshin

doi:10.1308/rcsann.2013.95.8.539

Cited by 36 publications

(24 citation statements)

References 28 publications

(28 reference statements)

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“…The skin island of $10 cm Â 20 cm for a VRAM flap allows for a quick assessment of blood flow through the deep inferior epigastric system and brings a bridge on neovascularization between the radiated area of the lower back and perineum. 29 The reconstruction of defects after APRS should be tailored to the individual patient. While several studies advocate VRAM as the optimal flap, decisions may differ.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned

Manrique

Rajesh

Asaad

et al. 2019

J reconstr Microsurg

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Background Abdominoperineal resection (APR), which involves resection of the rectum, anal canal, and perianal skin, results in a large dead space in the pelvis, devascularized tissues, and high bacterial loads. This predisposes to wound complications, especially in the setting of neoadjuvant chemoradiotherapy. Additional sacral resection further compounds these effects. We aimed to assess perineal wound outcomes and complications in patients who underwent flap reconstruction for APR with sacrectomy (APRS) at our institution. Methods We reviewed the charts of all patients who underwent flap reconstruction for APRS over a 20-year period (1999–2018). Medical comorbidities, details of the surgical procedure, and major and minor wound complications were recorded and analyzed. Results Forty-six patients underwent flap reconstruction following APRS—28 (60%) for colorectal cancer, 8 (17%) for sacral chordoma, and 10 diagnosed with other malignant histologies. Rectus abdominis myocutaneous (RAM) flap reconstruction was used in 42 patients (91%). The median time to the first major perineal complication was 111 days (interquartile range: 22–660 days). Half of our cohort (n = 23) experienced a major perineal complication. No significant differences were found in major or minor perineal or abdominal wall complications between RAM flap and other flaps. APR with high sacrectomy was performed in 27 patients (59%) and was associated with significantly increased full-thickness dehiscence in the perineal region when compared with APR with low sacrectomy, 33 versus 0%, respectively (p = 0.0076). Complete flap loss occurred in one patient. Conclusion The RAM flap was the workhorse flap for pelvic reconstruction following APRS in our cohort. Wound complications are common following APRS. High sacrectomy is associated with higher incidence of complications compared with low sacrectomy. Optimal surgical planning and patient counseling is fundamental to improve current surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned

Manrique

Rajesh

Asaad

et al. 2019

J reconstr Microsurg

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“…This study compares two alternative techniques for perineal defect reconstruction with the intention to provide a comparable patient collective and a comparable patient number. Concurrent techniques such as IGAP advancement flap or the posterior thigh flap are therefore not included (9,10,43).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous alternative techniques to the VRAM flap have been described, predominantly using abdominal, pudendal, gluteal, and thigh donor sites (2,9,10). Among those, is the myocutaneous gracilis flap (MGF), a well-described alternative to the VRAM flap for genital and perineal reconstruction (11,12).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Perineal Defects: A Comparison of the Myocutaneous Gracilis and the Gluteal Fold Flap in Interdisciplinary Anorectal Tumor Resection

et al. 2020

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Introduction:Resection of anorectal malignancies may result in extensive perineal/pelvic defects that require an interdisciplinary surgical approach involving reconstructive surgery. The myocutaneous gracilis flap (MGF) and the gluteal fold flap (GFF) are common options for defect coverage in this area. Here we report our experience with the MGF/GFF and compare the outcome regarding clinical key parameters. Methods: In a retrospective chart review, we collected data from the Department of Plastic Surgery of the University of Freiburg from December 2008-18 focusing on epidemiological, oncological, and therapy-related data including comorbidities (ASA Classification) and peri-/postoperative complications (Clavien-Dindo-System). Results: Twenty-nine patients were included with a mean follow-up of 17 months. Of the cases, 19 (65.5%) presented with recurrent disease, 21 (72.4%) received radiochemotherapy preoperatively, 2 (6.9%) received chemotherapy alone. Microscopic tumor free margins were achieved in 25 cases (86.2%). 17 patients (7 men, 10 women, rectal adenocarcinoma n = 11; anal squamous cell carcinoma n = 6; mean age 58.5 ± 10.68, mean BMI 23.1, mean ASA score 2.8) received a MGF (unilateral n = 10; bilateral n = 7). Twelve patients (7 men, 5 women, rectal adenocarcinoma n = 7; anal squamous cell carcinoma n = 4, proctodeal gland carcinoma n = 1, mean age 66.2 ± 9.2, mean BMI 23.6, mean ASA score 2.6) received coverage with a GFF (unilateral n = 4; bilateral n = 8). Mean operation time of coverage was 105 ± 9 min for unilateral and 163 ± 11 for bilateral MGFs, 70 ± 13 min for unilateral and 107 ± 14 for bilateral GFFs. Complications affected 62%. There was no significant difference in the complication rate between the MGF-and GFF-group. Complications were mainly wound healing disorders that did not extend the hospital stay. No flap loss and no complication that lead to long-lasting disability was documented (both groups). Pain-free sitting took more time in the GFF-group due to the location of the donor site. Conclusion: MG-flaps and GF-flaps prove to be reliable and robust techniques for perineal/pelvic reconstruction. Though flap elevation is significantly faster for GF-flaps, Thiele et al. Gracilis/Gluteal Fold for Perineal Coverage preoperative planning and intraoperative Doppler confirmation are advisable. With comparable complication rates, we suggest a decision-making based on distribution of adipose tissue for dead space obliteration, intraoperative patient positioning, and perforator vessel quality/distribution.

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“…Due to the size of such defects and poor general status of the oncological patient, the use of pedicled flaps emerged as the preferred reconstruction method. For large volume defects, occurring after pelvic exenteration, bulky flaps such as vertical rectus abdominis muscle (VRAM), gracilis, omentum are preferred, to fill the dead space and separate the abdominal contents from the pelvic cavity [6,21]. For superficial and limited volume defects fasciocutaneous flaps like gluteal, lotus, IGAP are preferred [21,22].…”

Section: Discussionmentioning

confidence: 99%

Bilateral V-Y advancement gluteal fold flaps following vulvo-vaginal melanoma resection

Pieptu¹,

Mihai²,

Gheţu³

et al. 2015

Arch Clin Cases

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The soft tissue defects of the anterior perineum can be caused by tumour excision, trauma, burns, Fournier's gangrene and genital mutilation. Various reconstruction methods were described: vacuum-assisted closure, skin grafts and skin substitutes, pedicled or free flaps. In the case of defects following oncologic surgery, flaps are the reconstructive method of choice. We present the case of a 65 year-old woman diagnosed with stage III A vulvovaginal melanoma affecting also the distal urethra. Radical vulvectomy and en-bloc excision of the anterior third of the vagina and distal urethra, along with bilateral inguinal lymphadenectomy was performed. The resulting defect was covered with bilateral V-Y advancement gluteal fold flaps. A local vaginal recurrence appeared 18 months after surgery and was safely removed. The patient followed chemotherapy with Dacarbazine. The gluteal fold flap offered good defect coverage and survived completely. Follow-up period was two years without distant metastases. Functional result was excellent, urinary function being normal and patient satisfaction high. Due to the gluteal flap's advantages (appropriate thickness, good vascularity, minimal donor site morbidity, and same operative field allowing for shorter operating time), reconstruction of the anterior perineum after oncological resection with bilateral V-Y advancement gluteal flaps is a viable solution.

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Reconstruction of perineal defects

Cited by 36 publications

References 28 publications

Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned

Surgical Outcomes after Abdominoperineal Resection with Sacrectomy and Soft Tissue Reconstruction: Lessons Learned

Reconstruction of Perineal Defects: A Comparison of the Myocutaneous Gracilis and the Gluteal Fold Flap in Interdisciplinary Anorectal Tumor Resection

Bilateral V-Y advancement gluteal fold flaps following vulvo-vaginal melanoma resection

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