Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review
Background:. Reconstruction after abdominoperineal resection (APR) typically utilizes primary closure, locoregional myocutaneous flaps (gracilis or vertical rectus myocutaneous [VRAM]), or omental flaps. Although flap coverage is considered superior to primary closure, no specific flap is preferred,...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2025-04-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006738 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849311317101379584 |
|---|---|
| author | Zachary Gala, MD Mehdi S. Lemdani, BA Jane N. Ewing, BS J. Reed McGraw, BA Dustin T. Crystal, MD Ellen Niu, BA Irfan A. Rhemtulla, MD, MS Robyn B. Broach, PhD Najjia N. Mahmoud, MD Stephen J. Kovach, MD |
| author_facet | Zachary Gala, MD Mehdi S. Lemdani, BA Jane N. Ewing, BS J. Reed McGraw, BA Dustin T. Crystal, MD Ellen Niu, BA Irfan A. Rhemtulla, MD, MS Robyn B. Broach, PhD Najjia N. Mahmoud, MD Stephen J. Kovach, MD |
| author_sort | Zachary Gala, MD |
| collection | DOAJ |
| description | Background:. Reconstruction after abdominoperineal resection (APR) typically utilizes primary closure, locoregional myocutaneous flaps (gracilis or vertical rectus myocutaneous [VRAM]), or omental flaps. Although flap coverage is considered superior to primary closure, no specific flap is preferred, and reconstructive complications can occur in 20%–50% patients. The purpose of this study was to compare outcomes of perineal reconstruction with VRAM, gracilis, and omental flaps.
Methods:. A single-institution retrospective cohort review was performed on all adult patients who underwent APR defect reconstruction with VRAM, gracilis, or omental flaps by the plastic surgery service between 2014 and 2023. Demographic, operative, and outcomes-associated variables were noted (surgical site infection, nonhealing wounds, flap necrosis/failure, need for additional procedures/operations, etc.).
Results:. A total of 80 patients were identified, 11 diagnosed with inflammatory bowel disease (1 Crohn disease and 10 ulcerative colitis), and 58 diagnosed with colorectal cancer. Flap reconstruction was as follows: 24 VRAM, 49 gracilis, 7 omental. Mean follow-up was 34.9 months (1.56 wk, 9.12 y). Enterocutaneous fistula formation was significantly more likely in VRAM versus gracilis flaps (gracilis odds ratio: 0.11, P = 0.02), when adjusted for neoadjuvant chemoradiation. Overall complication rate was 72.5% of patients, of whom 45% required procedural intervention.
Conclusions:. Perineal reconstruction after APR can be achieved by various methods. Although the literature has shown flap closure to be more efficacious, differences in overall postoperative complication rate across flap type are minimal. Alternatives to VRAM reconstruction should be considered in patients predisposed to fistula formation. |
| format | Article |
| id | doaj-art-88b5aba388e14e97a8441ed2ea8aa590 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-88b5aba388e14e97a8441ed2ea8aa5902025-08-20T03:53:27ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-04-01134e673810.1097/GOX.0000000000006738202504000-00075Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective ReviewZachary Gala, MD0Mehdi S. Lemdani, BA1Jane N. Ewing, BS2J. Reed McGraw, BA3Dustin T. Crystal, MD4Ellen Niu, BA5Irfan A. Rhemtulla, MD, MS6Robyn B. Broach, PhD7Najjia N. Mahmoud, MD8Stephen J. Kovach, MD9From the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PAFrom the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA‡ Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.From the * Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PABackground:. Reconstruction after abdominoperineal resection (APR) typically utilizes primary closure, locoregional myocutaneous flaps (gracilis or vertical rectus myocutaneous [VRAM]), or omental flaps. Although flap coverage is considered superior to primary closure, no specific flap is preferred, and reconstructive complications can occur in 20%–50% patients. The purpose of this study was to compare outcomes of perineal reconstruction with VRAM, gracilis, and omental flaps. Methods:. A single-institution retrospective cohort review was performed on all adult patients who underwent APR defect reconstruction with VRAM, gracilis, or omental flaps by the plastic surgery service between 2014 and 2023. Demographic, operative, and outcomes-associated variables were noted (surgical site infection, nonhealing wounds, flap necrosis/failure, need for additional procedures/operations, etc.). Results:. A total of 80 patients were identified, 11 diagnosed with inflammatory bowel disease (1 Crohn disease and 10 ulcerative colitis), and 58 diagnosed with colorectal cancer. Flap reconstruction was as follows: 24 VRAM, 49 gracilis, 7 omental. Mean follow-up was 34.9 months (1.56 wk, 9.12 y). Enterocutaneous fistula formation was significantly more likely in VRAM versus gracilis flaps (gracilis odds ratio: 0.11, P = 0.02), when adjusted for neoadjuvant chemoradiation. Overall complication rate was 72.5% of patients, of whom 45% required procedural intervention. Conclusions:. Perineal reconstruction after APR can be achieved by various methods. Although the literature has shown flap closure to be more efficacious, differences in overall postoperative complication rate across flap type are minimal. Alternatives to VRAM reconstruction should be considered in patients predisposed to fistula formation.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006738 |
| spellingShingle | Zachary Gala, MD Mehdi S. Lemdani, BA Jane N. Ewing, BS J. Reed McGraw, BA Dustin T. Crystal, MD Ellen Niu, BA Irfan A. Rhemtulla, MD, MS Robyn B. Broach, PhD Najjia N. Mahmoud, MD Stephen J. Kovach, MD Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review Plastic and Reconstructive Surgery, Global Open |
| title | Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review |
| title_full | Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review |
| title_fullStr | Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review |
| title_full_unstemmed | Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review |
| title_short | Longitudinal Outcomes of Abdominoperineal Resection Reconstruction: A Single-center Retrospective Review |
| title_sort | longitudinal outcomes of abdominoperineal resection reconstruction a single center retrospective review |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006738 |
| work_keys_str_mv | AT zacharygalamd longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT mehdislemdaniba longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT janenewingbs longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT jreedmcgrawba longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT dustintcrystalmd longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT ellenniuba longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT irfanarhemtullamdms longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT robynbbroachphd longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT najjianmahmoudmd longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview AT stephenjkovachmd longitudinaloutcomesofabdominoperinealresectionreconstructionasinglecenterretrospectivereview |