Use of myocutaneous flaps for perineal closure following abdominoperineal excision of the rectum for adenocarcinoma

Introduction  Abdominoperineal excision (APE) following radiotherapy is associated with a high rate of perineal wound complications. The use of myocutaneous flaps may improve wound healing. We present our experience using myocutaneous flaps for immediate reconstruction. Method  Prospective data were...

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Bibliographic Details
Published in:Colorectal disease 2010-06, Vol.12 (6), p.555-560
Main Authors: Chan, S., Miller, M., Ng, R., Ross, D., Roblin, P., Carapeti, E., Williams, A. B., George, M. L.
Format: Article
Language:English
Subjects:
Abdomen - surgery
abdominoperineal excision
Adenocarcinoma - radiotherapy
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Animals
Female
Humans
Length of Stay
Male
Middle Aged
myocutaneous flap
Perineum - surgery
Postoperative Complications
Reconstructive Surgical Procedures
rectal adenocarcinoma
Rectal Neoplasms - radiotherapy
Rectal Neoplasms - surgery
Rectus Abdominis - surgery
Surgical Flaps
Wound Healing
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Summary:Introduction  Abdominoperineal excision (APE) following radiotherapy is associated with a high rate of perineal wound complications. The use of myocutaneous flaps may improve wound healing. We present our experience using myocutaneous flaps for immediate reconstruction. Method  Prospective data were collected on patients undergoing APE from October 2003 to December 2008. Patient demographics, operating time, wound complications and length of stay were recorded. Results  Fifty‐one patients underwent APE for rectal adenocarcinoma, 21 had primary closure and 30 had myocutaneous flap closure (24 VRAM, 6 gracilis). The proportion of patients undergoing preoperative radiotherapy in each group were 62% and 93% respectively (P = 0.011). There were no major complications following primary closure of the unirradiated perineum. Major perineal wound complications requiring reoperation or debridement were seen in three (14%) patients following primary closure and five (17%) patients with flap closure. After radiotherapy, closure with a flap reduced the length of stay from 20 to 15 days, but this difference was not statistically significant (P = 0.36). Conclusion  The use of flap closure in irradiated patients is associated with fewer perineal complications and a shorter hospital stay.
ISSN:1462-8910
1463-1318
DOI:10.1111/j.1463-1318.2009.01844.x