Coltro Pedro S, Busnardo Fábio F, Mônaco Filho Franklin C, Olivan Marcelo V, Millan Lincoln S, Grillo Victor A, Marques Carlos F, Nahas Caio S, Nahas Sérgio C, Ribeiro Ulysses, Gemperli Rolf
1 Division of Plastic Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil 2 Division of Plastic Surgery, Medical School, University of São Paulo, São Paulo, Brazil 3 Division of Gastroenterology Surgery and Coloproctology, Medical School, University of São Paulo, São Paulo, Brazil.
Dis Colon Rectum. 2017 Sep;60(9):945-953. doi: 10.1097/DCR.0000000000000875.
There are many previous reports for using the internal pudendal artery perforator flap in vulvovaginal reconstruction; however, reports of this flap for perineal reconstruction after abdominoperineal excision of the rectum are scarce.
The purpose of this study was to evaluate the outcomes of immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects.
This was a prospective case series.
This flap could represent a step forward over other perineal flap approaches or primary closure.
A total of 73 consecutive patients with anorectal tumors were included.
The study included immediate perineal reconstruction using 122 internal pudendal artery perforator flaps after abdominoperineal excision of the rectum.
Dimensions of the perineal defect (in centimeters squared), hospital stay (days), healing time (days), and postoperative complications (Clavien-Dindo grades) were measured.
The means of the perineal defect, hospital stay, and healing time were 51.62 cm, 15.94 days, and 38.52 days. The higher the patient BMI, the longer healing time (p = 0.02); Clavien-Dindo complications grades III to IV were greater in patients with perineal defect ≥60 cm (p = 0.03; OR = 10.56); postoperative complications were higher both in patients with anal squamous cell carcinoma (p = 0.005; OR = 6.09) and in patients with comorbidities (p = 0.04; OR = 2.78); hospital stay (p= 0.001) and healing time (p < 0.001) were higher in patients who had postoperative complications. The complete perineal wound healing at 12 weeks was achieved by 95% of patients, and our 30-day mortality rate was 4%.
As a nonrandomized study, our results have to be interpreted with caution.
Multiple previously described advantages associated with internal pudendal artery perforator flap were also observed here, reinforcing the idea that it is reliable, versatile, and a useful option for perineal reconstruction after abdominoperineal excision of the rectum. Therefore, we propose that this flap could be considered as the first choice for perineal reconstruction in selected patients with moderate and some large defects after abdominoperineal excision of the rectum. See Video Abstract at http://links.lww.com/DCR/A367.
以往有许多关于使用阴部内动脉穿支皮瓣进行外阴阴道重建的报道；然而，关于该皮瓣用于直肠癌腹会阴切除术后会阴重建的报道却很少。
本研究旨在评估即刻阴部内动脉穿支皮瓣重建术治疗放射性腹会阴切除术后缺损的效果。
这是一项前瞻性病例系列研究。
与其他会阴皮瓣方法或一期缝合相比，该皮瓣可能是一个进步。
共纳入73例连续的肛管直肠肿瘤患者。
本研究包括在直肠癌腹会阴切除术后使用122块阴部内动脉穿支皮瓣进行即刻会阴重建。
测量会阴缺损面积（平方厘米）、住院时间（天）、愈合时间（天）和术后并发症（Clavien-Dindo分级）。
会阴缺损、住院时间和愈合时间的平均值分别为51.62平方厘米、15.94天和38.52天。患者体重指数越高，愈合时间越长（p = 0.02）；会阴缺损≥60平方厘米的患者中，Clavien-Dindo并发症Ⅲ至Ⅳ级的发生率更高（p = 0.03；OR = 10.56）；肛门鳞状细胞癌患者（p = 0.005；OR = 6.09）和合并症患者（p = 0.04；OR = 2.78）的术后并发症发生率更高；发生术后并发症的患者住院时间（p = 0.001）和愈合时间（p < 0.001）更长。95%的患者在12周时会阴伤口完全愈合，我们的30天死亡率为4%。
作为一项非随机研究，我们的结果必须谨慎解读。
本研究还观察到了阴部内动脉穿支皮瓣先前描述的多种优势，进一步证明了其可靠、通用，是直肠癌腹会阴切除术后会阴重建的一种有用选择。因此，我们建议，对于直肠癌腹会阴切除术后有中度和部分较大缺损的特定患者，该皮瓣可被视为会阴重建的首选。见视频摘要：http://links.lww.com/DCR/A367 。
