1The Department of Plastic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 2The Department of General Surgery, Division of Colon and Rectal Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
Dis Colon Rectum. 2014 Jun;57(6):725-32. doi: 10.1097/DCR.0000000000000103.
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.
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.
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.
This study was conducted at an academic, tertiary-care cancer center.
Patients in the study were patients with cancer who were receiving perineal reconstruction.
Interventions were surgical and included either abdomen- or thigh-based reconstruction.
The main outcome measures included infection, flap failure, length of stay, and time to radiotherapy.
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).
The limitations of this study include a relatively small sample size and retrospective evaluation.
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).
腹会阴联合切除术是一种有创手术，会在患者的骨盆留下巨大的死腔。传统上，使用垂直腹直肌肌皮瓣来重建这些缺陷。但由于多次造口或先前的腹部手术，常常无法使用该皮瓣。股前外侧皮瓣可以使用；然而，该皮瓣的效果一直存在争议。
我们报告了一位外科医生在癌症患者会阴重建中使用垂直腹直肌肌皮瓣或股前外侧皮瓣的经验，以证明两种修复方式都能获得可接受的结果。
从 2010 年到 2012 年，19 名连续的癌症患者因癌症导致会阴缺陷，接受了皮瓣重建。对前瞻性入组数据进行回顾性图表审查，以确定短期和长期并发症的发生率。
这项研究在一家学术性三级癌症中心进行。
研究中的患者为接受会阴重建的癌症患者。
干预措施为手术，包括腹部或股部皮瓣重建。
主要观察指标包括感染、皮瓣失败、住院时间和放疗时间。
在我们的研究中，19 名患者中有 10 名接受股前外侧皮瓣，9 名接受垂直腹直肌肌皮瓣重建。两组患者的人口统计学特征无显著差异（p＞0.05）。手术结果和并发症方面，感染、血肿、出血或坏死的发生率无显著差异。股前外侧皮瓣组重建后平均住院时间为 9.7±3.4 天，垂直腹直肌肌皮瓣组为 13.4±7.7 天（p＞0.05）。
本研究的局限性包括样本量相对较小和回顾性评估。
本研究表明，股前外侧皮瓣是会阴重建的一种可接受的垂直腹直肌肌皮瓣替代方法（见视频，补充数字内容 1，http://links.lww.com/DCR/A134）。
