The Inferior Gluteal Artery Myocutaneous Flap Is Preferable for Reconstructing the Complex Perineal Defect Following Pelvic Exenteration

Chauhan, Abha; Morrison, Edwin; Lonie, Sarah; Sham, Eric; Heriot, Alexander

doi:10.1097/01.gox.0000720672.09757.be

Cited by 2 publications

(6 citation statements)

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“…3 Because of this, several techniques over the years have been examined to see whether they improve wound healing outcomes, including the utilization of myocutaneous flaps like the vertical rectus abdominus myocutaneous (VRAM) and IGAM flaps. 5,7,11 The use of the IGAM flap has been favoured by many institutions as it is a relatively simple technique with minimal donor complications when compared to the VRAM flap. 5,7,11 This study identified 102 patients who underwent APR for malignancy and either had primary perineal closure or an IGAM reconstruction performed by the plastic surgical team.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,11 The use of the IGAM flap has been favoured by many institutions as it is a relatively simple technique with minimal donor complications when compared to the VRAM flap. 5,7,11 This study identified 102 patients who underwent APR for malignancy and either had primary perineal closure or an IGAM reconstruction performed by the plastic surgical team. Those who had planned IGAM reconstruction were those who either had anal squamous cell carcinoma which was refractory to neoadjuvant therapy or those cancers with an advanced T stage and involving adjacent anatomical structures such as the pelvic floor or the vagina.…”

Section: Discussionmentioning

confidence: 99%

“…APR is a complex procedure which is associated with significant complications, in particular, perineal wound breakdown 3 . Because of this, several techniques over the years have been examined to see whether they improve wound healing outcomes, including the utilization of myocutaneous flaps like the vertical rectus abdominus myocutaneous (VRAM) and IGAM flaps 5,7,11 . The use of the IGAM flap has been favoured by many institutions as it is a relatively simple technique with minimal donor complications when compared to the VRAM flap 5,7,11 …”

Section: Discussionmentioning

confidence: 99%

“…Perineal reconstruction can be broadly classified into either primary closure (PC) or myocutaneous flap based reconstruction, 4 with the inferior gluteal artery myocutaneous (IGAM) flap being a commonly utilized technique to reconstruct large perineal defects. 5 The advantage of the IGAM flap is that it utilizes non-irradiated skin and muscle to facilitate wound healing through a reliably vascularised flap 6,7 Recent position statements from the American College of Colorectal Surgeons (ACCRS) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) conclude that current evidence is insufficient to recommend which technique should be utilized. 8,9 Our institution is a high-volume tertiary referral centre for colorectal cancer surgery in Melbourne, and we have previously described our early experience with the IGAM flap for the reconstruction of APR defects.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of perineal reconstruction with inferior gluteal artery myocutaneous flaps and primary closure following abdominoperineal resection

Gultekin

Gartrell

Croxford

et al. 2022

ANZ Journal of Surgery

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Background: Perineal wound morbidity following abdominoperineal resection (APR) is a significant challenge. Myocutaneous flap-based techniques have been developed to overcome morbidity associated with perineal reconstruction. We reviewed outcomes for patients undergoing APR in a hospital that performs inferior gluteal artery myocutaneous (IGAM) island transposition flaps and primary closure (PC) for perineal reconstruction. Methods: A retrospective study of patients who underwent APR for malignancy between January 2012 and March 2020 was performed and outcomes between IGAM reconstruction and PC compared. Primary outcomes were wound infection and dehiscence. Secondary outcomes included return to theatre, operative time, length of stay, flap loss and perineal hernia incidence.Results: One-hundred and two patients underwent APR, with 50 (49%) who had PC and 52 (51%) had IGAM flap reconstructions. There were no differences between each group with regards to wound infection (23 vs. 22%, P = 0.55) or wound dehiscence (25 vs. 24%, P = 0.92). Thirteen (25%) IGAM patients required a return to theatre compared to three PC patients (6%) (P = 0.008). IGAM procedures required twice the overall operative time (506 vs. 240 min, P = 0.001) with no differences between groups when comparing the APR component (250 vs. 240 min, P = 0.225). The IGAM group had a longer length of stay (median 13 days vs. 9 days, P = 0.001). Only one IGAM flap was lost and no symptomatic hernias were identified. Conclusion: Perineal closure technique did not affect the incidence of wound infection or dehiscence. Closure technique should be tailored to underlying patient characteristics and surgical pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes of perineal reconstruction with inferior gluteal artery myocutaneous flaps and primary closure following abdominoperineal resection

Gultekin

Gartrell

Croxford

et al. 2022

ANZ Journal of Surgery

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Evaluating postoperative hernia incidence and risk factors following pelvic exenteration

Milanko,

Kelly,

Turner

et al. 2024

Int J Colorectal Dis

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Pelvic exenteration (PE) is a technically challenging surgical procedure. More recently, quality of life and survivorship following PEs are being increasingly acknowledged as important patient outcomes. This includes evaluating major long-term complications such as hernias, defined as the protrusion of internal organs through a facial defect (The PelvEx Collaborative in Br J Surg 109:1251–1263, 2022), for which there is currently limited literature. The aim of this paper is to ascertain the incidence and risk factors for postoperative hernia formation among our PE cohort managed at a quaternary centre. Method A retrospective cohort study examining hernia formation following PE for locally advanced rectal carcinoma and locally recurrent rectal carcinoma between June 2010 and August 2022 at a quaternary cancer centre was performed. Baseline data evaluating patient characteristics, surgical techniques and outcomes was collated among a PE cohort of 243 patients. Postoperative hernia incidence was evaluated via independent radiological screening and clinical examination. Results A total of 79 patients (32.5%) were identified as having developed a hernia. Expectantly, those undergoing flap reconstruction had a lower incidence of postoperative hernias. Of the 79 patients who developed postoperative hernias, 16.5% reported symptoms with the most common symptom reported being pain. Reintervention was required in 18 patients (23%), all of which were operative. Conclusion This study found over one-third of PE patients developed a hernia postoperatively. This paper highlights the importance of careful perioperative planning and optimization of patients to minimize morbidity.

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The Inferior Gluteal Artery Myocutaneous Flap Is Preferable for Reconstructing the Complex Perineal Defect Following Pelvic Exenteration

Cited by 2 publications

References 0 publications

Outcomes of perineal reconstruction with inferior gluteal artery myocutaneous flaps and primary closure following abdominoperineal resection

Outcomes of perineal reconstruction with inferior gluteal artery myocutaneous flaps and primary closure following abdominoperineal resection

Evaluating postoperative hernia incidence and risk factors following pelvic exenteration

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