di Summa Pietro G, Matter Maurice, Kalbermatten Daniel F, Bauquis Olivier, Raffoul Wassim
Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Department of Visceral Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
J Plast Reconstr Aesthet Surg. 2016 Mar;69(3):359-67. doi: 10.1016/j.bjps.2015.10.044. Epub 2015 Nov 5.
Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study.
Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed.
Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits.
The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor.
放疗后的腹会阴联合切除术（APR）与较高的会阴伤口并发症发生率相关。股前外侧（ALT）皮瓣联合股外侧肌（VL）可覆盖复杂的会阴和骨盆前后位缺损。本研究首次经腹通过骨盆和会阴以向后下的方向使用该皮瓣；本文对此技术进行了描述和说明。
在2004年5月至2011年6月期间接受会阴重建的90余例患者中，6例患者存在侵犯会阴、骨盆和骶骨的高级别肿瘤，从而导致连续性的前后位缺损。在扩大的APR及随后的骶骨切除术后，进行ALT + VL经腹会阴途径（TAPP）重建。对患者进行回顾性检查以确定人口统计学资料、手术时间、并发症（全身及皮瓣相关）、完全愈合时间和住院时间。评估皮瓣的长期覆盖情况、皮瓣体积稳定性以及功能和美学效果。
重建的平均手术时间为290分钟。无死亡病例。1例患者出现部分皮瓣坏死。另1例患者在皮瓣愈合后出现新的伤口裂开，原因是原发性肿瘤的继发性皮肤播散。在术后系列CT扫描进行皮瓣体积分析后，未观察到明显的皮瓣萎缩。所有皮瓣均完全覆盖缺损。未发生瘘管或会阴疝等晚期并发症。供区恢复顺利，无功能缺陷。
经腹使用ALT + VL皮瓣是一种重建延伸至下背部的极其复杂的会阴和骨盆缺损的创新方法。该皮瓣可保证良好的体积，消除所有盆腔死腔，阔筋膜（FL）支撑盆底。
