Abdominal-Versus thigh-based reconstruction of perineal defects in patients with cancer

John Pang, Justin M. Broyles, Jens Berli, Kate Buretta, Sachin M. Shridharani, Danielle H. Rochlin, Jonathan E. Efron, Justin M. Sacks

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned. OBJECTIVE: We report a single surgeon's experience with perineal reconstruction in patients with cancer with the use of either the vertical rectus abdominus myocutaneous flap or the anterolateral thigh flap to demonstrate acceptable outcomes with either repair modality. DESIGN: From 2010 to 2012, 19 consecutive patients with perineal defects secondary to cancer underwent flap reconstruction. A retrospective chart review of prospectively entered data was conducted to determine the frequency of short-term and long-term complications. SETTINGS: This study was conducted at an academic, tertiary-care cancer center. PATIENTS: Patients in the study were patients with cancer who were receiving perineal reconstruction. INTERVENTIONS: Interventions were surgical and included either abdomen- or thigh-based reconstruction. MAIN OUTCOME MEASURES: The main outcome measures included infection, flap failure, length of stay, and time to radiotherapy. RESULTS: Of the 19 patients included in our study, 10 underwent anterolateral thigh flaps and 9 underwent vertical rectus abdominus myocutaneous flaps for reconstruction. There were no significant differences in demographics between groups (p > 0.05). Surgical outcomes and complications demonstrated no significant differences in the rate of infection, hematoma, bleeding, or necrosis. The mean length of stay after reconstruction was 9.7 ± 3.4 days (± SD) in the anterolateral thigh flap group and 13.4 ± 7.7 days in the vertical rectus abdominus myocutaneous flap group (p > 0.05). LIMITATIONS: The limitations of this study include a relatively small sample size and retrospective evaluation. CONCLUSION: This study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).

Original languageEnglish (US)
Pages (from-to)725-732
Number of pages8
JournalDiseases of the Colon and Rectum
Volume57
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Rectus Abdominis
Thigh
Myocutaneous Flap
Neoplasms
Length of Stay
Ostomy
Infection
Tertiary Care Centers
Hematoma
Abdomen
Sample Size
Necrosis
Radiotherapy
Demography
Outcome Assessment (Health Care)
Hemorrhage

Keywords

  • Abdominoperineal resection reconstruction
  • Anterolateral thigh flap
  • LCF flap
  • Perineal reconstruction
  • Vaginal reconstruction
  • Vertical rectus abdominus myocutaneous flap

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

Pang, J., Broyles, J. M., Berli, J., Buretta, K., Shridharani, S. M., Rochlin, D. H., ... Sacks, J. M. (2014). Abdominal-Versus thigh-based reconstruction of perineal defects in patients with cancer. Diseases of the Colon and Rectum, 57(6), 725-732. https://doi.org/10.1097/DCR.0000000000000103

Abdominal-Versus thigh-based reconstruction of perineal defects in patients with cancer. / Pang, John; Broyles, Justin M.; Berli, Jens; Buretta, Kate; Shridharani, Sachin M.; Rochlin, Danielle H.; Efron, Jonathan E.; Sacks, Justin M.

In: Diseases of the Colon and Rectum, Vol. 57, No. 6, 2014, p. 725-732.

Research output: Contribution to journalArticle

Pang, J, Broyles, JM, Berli, J, Buretta, K, Shridharani, SM, Rochlin, DH, Efron, JE & Sacks, JM 2014, 'Abdominal-Versus thigh-based reconstruction of perineal defects in patients with cancer', Diseases of the Colon and Rectum, vol. 57, no. 6, pp. 725-732. https://doi.org/10.1097/DCR.0000000000000103
Pang, John ; Broyles, Justin M. ; Berli, Jens ; Buretta, Kate ; Shridharani, Sachin M. ; Rochlin, Danielle H. ; Efron, Jonathan E. ; Sacks, Justin M. / Abdominal-Versus thigh-based reconstruction of perineal defects in patients with cancer. In: Diseases of the Colon and Rectum. 2014 ; Vol. 57, No. 6. pp. 725-732.
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AU - Rochlin, Danielle H.

AU - Efron, Jonathan E.

AU - Sacks, Justin M.

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N2 - BACKGROUND: An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned. OBJECTIVE: We report a single surgeon's experience with perineal reconstruction in patients with cancer with the use of either the vertical rectus abdominus myocutaneous flap or the anterolateral thigh flap to demonstrate acceptable outcomes with either repair modality. DESIGN: From 2010 to 2012, 19 consecutive patients with perineal defects secondary to cancer underwent flap reconstruction. A retrospective chart review of prospectively entered data was conducted to determine the frequency of short-term and long-term complications. SETTINGS: This study was conducted at an academic, tertiary-care cancer center. PATIENTS: Patients in the study were patients with cancer who were receiving perineal reconstruction. INTERVENTIONS: Interventions were surgical and included either abdomen- or thigh-based reconstruction. MAIN OUTCOME MEASURES: The main outcome measures included infection, flap failure, length of stay, and time to radiotherapy. RESULTS: Of the 19 patients included in our study, 10 underwent anterolateral thigh flaps and 9 underwent vertical rectus abdominus myocutaneous flaps for reconstruction. There were no significant differences in demographics between groups (p > 0.05). Surgical outcomes and complications demonstrated no significant differences in the rate of infection, hematoma, bleeding, or necrosis. The mean length of stay after reconstruction was 9.7 ± 3.4 days (± SD) in the anterolateral thigh flap group and 13.4 ± 7.7 days in the vertical rectus abdominus myocutaneous flap group (p > 0.05). LIMITATIONS: The limitations of this study include a relatively small sample size and retrospective evaluation. CONCLUSION: This study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).

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