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Patient: Male, 49Final Diagnosis: Anal squamo cell carcinomaSymptoms: Inguinal mass • inflammation • perineal tumorMedication: —Clinical Procedure: Abdominoperineal resection (APR) • groin dissection and closure of the inguinal defect with oblique rectus abdominis myocutaneous (ORAM) flapSpecialty: SurgeryObjective:Unusual setting of medical careBackground:Anal squamous cell carcinoma accounts for about 2–4% of all lower gastrointestinal malignancies, with a distant disease reported in less than 5%. Although surgical treatment is rarely necessary, this often involve large dissections and difficult reconstructive procedures.Case Report:We present a complex but successful case of double-flap reconstruction after abdominoperineal resection and groin dissection for anal squamous cell carcinoma (cT3N3M0) with metastatic right inguinal lymph nodes and ipsilateral threatening of femoral vessels. A multi-specialty team was involved in the operation. A vascular and plastic surgeon performed the inguinal dissection with en bloc excision of the saphenous magna and a cuff of the femoral vein, while colorectal surgeons carried out the abdominoperineal excision. The 2 large tissue gaps at the groin and perineum were covered with an oblique rectus abdominis myocutaneous flap and a gluteal lotus flap, respectively. A partially absorbable mesh was placed at the level of the anterior sheath in order to reinforce the abdominal wall, whereas an absorbable mesh was used as a bridge for the dissected pelvic floor muscles. The post-operative period was uneventful and the follow-up at 5 months showed good results.Conclusions:An early diagnosis along with new techniques of radiochemotherapy allow patients to preserve their sphincter function. However, a persistent or recurrent disease needs major operations, which often involve a complex reconstruction. Good team-work and experience in specialized fields give the opportunity to make the best choices to perform critical steps during the management of complex cases.
Patient: Male, 49Final Diagnosis: Anal squamo cell carcinomaSymptoms: Inguinal mass • inflammation • perineal tumorMedication: —Clinical Procedure: Abdominoperineal resection (APR) • groin dissection and closure of the inguinal defect with oblique rectus abdominis myocutaneous (ORAM) flapSpecialty: SurgeryObjective:Unusual setting of medical careBackground:Anal squamous cell carcinoma accounts for about 2–4% of all lower gastrointestinal malignancies, with a distant disease reported in less than 5%. Although surgical treatment is rarely necessary, this often involve large dissections and difficult reconstructive procedures.Case Report:We present a complex but successful case of double-flap reconstruction after abdominoperineal resection and groin dissection for anal squamous cell carcinoma (cT3N3M0) with metastatic right inguinal lymph nodes and ipsilateral threatening of femoral vessels. A multi-specialty team was involved in the operation. A vascular and plastic surgeon performed the inguinal dissection with en bloc excision of the saphenous magna and a cuff of the femoral vein, while colorectal surgeons carried out the abdominoperineal excision. The 2 large tissue gaps at the groin and perineum were covered with an oblique rectus abdominis myocutaneous flap and a gluteal lotus flap, respectively. A partially absorbable mesh was placed at the level of the anterior sheath in order to reinforce the abdominal wall, whereas an absorbable mesh was used as a bridge for the dissected pelvic floor muscles. The post-operative period was uneventful and the follow-up at 5 months showed good results.Conclusions:An early diagnosis along with new techniques of radiochemotherapy allow patients to preserve their sphincter function. However, a persistent or recurrent disease needs major operations, which often involve a complex reconstruction. Good team-work and experience in specialized fields give the opportunity to make the best choices to perform critical steps during the management of complex cases.
Background/Aim: This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. Materials and Methods: A systematic literature search was performed according to the PRISMA statement between 1996-2016. Results: A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. Conclusion: Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery. The inguinal region represents a crucial intersection of fundamental anatomical structures, such as the femoral artery, vein, nerve, the inguinal node stations and the inguinal canal. This makes the inguinal carrefour a common surgical site for interventions that range from surgical lymphadenectomy, diverse oncological resections to a number of vascular, visceral and urological surgical procedures. Such procedures may result in soft tissue defects and exposure of key anatomic elements, requiring reconstruction. However, if radical inguinal oncological surgery is more likely to produce a primary defect or dead space, vascular and general surgery procedures, may incur wound dehiscence, delayed healing, and abscess formation, finally requiring radical aggressive debridement leading to a secondary soft tissue and skin defect. The anatomical features of inguinal defects in the particular location between the abdominal and the thigh, and in the vicinity of the anogenital region, make the reconstruction of the inguinal region challenging for the plastic surgeon. The poor healing of wounds in the inguinal region has been attributed to wide defects with bacterial contamination, noncollapsible dead spaces, lymphatic leaks and the healing difficulties related to a low vascularized, or eventually irradiated field (1, 2), depending on the primary pathology. The post-operative morbidity associated with inguinal surgery is well documented in the literature, with an incidence of complications as high as 40% (3). The aims of this systematic literature review were to comprehensively review the last two decades of literature concerning inguinal reconstructions, focusing on etiology, and associated reconstruction techniques and outcomes with complications associated with respective etiology and 1 This article is freely accessible online.
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