Vertical Rectus Abdominis Musculocutaneous Flap Repair Improves Perineal Wound Healing After Abdominoperineal Resection for Irradiated Locally Advanced Rectal Cancer

Levy, S; Serror, Kévin; Boccara, David

doi:10.1245/s10434-018-6562-y

Cited by 6 publications

(1 citation statement)

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“…The GT-flap has a favourable profile, compared to existing literature on flap repair [7, 9]. There seems to be no partial necrosis of the flap or total flap loss, as can be observed with muscle flaps, although the sample size is still small [18]. The procedure can be combined with laparoscopy, contrary to conventional VRAM flaps for example.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer

et al. 2019

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BackgroundAbdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel gluteal turnover flap (GT-flap) without donor site scar for perineal closure after APR.MethodsConsecutive patients who underwent APR for primary or recurrent rectal cancer were included in a prospective non-randomised pilot study in two academic centres. Perineal reconstruction consisted of a unilateral subcutaneous GT-flap, followed by midline closure. Feasibility was defined as uncomplicated perineal wound healing at 30 days in at least five patients, and a maximum of two flap failures.ResultsOut of 17 potentially eligible patients, 10 patients underwent APR with GT-flap-assisted perineal wound closure. Seven patients had pre-operative radiotherapy. Median-added theatre time was 38 min (range 35–44 min). Two patients developed a superficial perineal wound dehiscence, most likely because of the excessive width of the skin island. Two other patients developed purulent discharge and excessive serosanguinous discharge, respectively, resulting in four complicated wounds at 30 days. No flap failure occurred, and no radiological or surgical reinterventions were performed. Median length of hospital stay was 10 days (IQR 8–12 days).ConclusionsThe GT-flap for routine perineal wound closure after APR seems feasible with limited additional theatre time, but success seems to depend on correct planning of the width of the flap. The potential for reducing perineal morbidity should be evaluated in a randomised controlled trial.Electronic supplementary materialThe online version of this article (10.1007/s10151-019-02055-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%