Özkaya Özay, Ergan Şahin Ayça, Üsçetin İlker, Güven Hakan, Sağlam Fazil
Ann Plast Surg. 2018 Feb;80(2):154-158. doi: 10.1097/SAP.0000000000001234.
According to National Cancer Institute, there are approximately 39,800 rectal cancer cases per year, 25% of which will need an abdominoperineal resection (APR). The key to avoid most of the complications related to pelvic defect that occurs after APR is choosing an appropriate reconstruction option for perineum. This study aims to introduce an easily applicable flap option for closure to address postoperative pelvic defect in low rectal cancer.
This is a retrospective evaluation of 9 patients who have undergone perineal reconstruction for pelvic defects after extralevatory abdominoperineal excision with rectal cancer between 2014 and 2016. Reconstruction consists of a novel technique defined by our clinic, which is buried desepidermised fasciocutaneous V-Y advancement flap.
All defects are closed successfully. Patients are followed postoperatively for complications such as perineal infection, wound dehiscence, seroma, perineal sinus, or fistula formation. Flaps are evaluated with magnetic resonance imaging postoperatively, for viability and effectiveness on defect closure. Mean follow-up time is 20 (±9) months. Mean average hospital stay is 8 (±2) days. We did not experience any total or partial flap loss or encounter any local complication related to the wound.
Buried desepidermised fasciocutaneous V-Y advancement flap is a reasonably easy and time-saving operation. It is effective in filling the pelvic dead space while closing the sacral defect after APR and therefore decreases late term complications related to large perineal excision.
根据美国国立癌症研究所的数据，每年约有39800例直肠癌病例，其中25%需要进行腹会阴联合切除术（APR）。避免APR术后与盆腔缺损相关的大多数并发症的关键在于为会阴选择合适的重建方案。本研究旨在介绍一种易于应用的皮瓣选择用于闭合，以解决低位直肠癌术后的盆腔缺损问题。
这是一项对2014年至2016年间因直肠癌行扩大腹会阴切除术后盆腔缺损进行会阴重建的9例患者的回顾性评估。重建采用了我们诊所定义的一种新技术，即埋藏去表皮筋膜皮瓣V-Y推进皮瓣。
所有缺损均成功闭合。术后对患者进行随访，观察会阴感染、伤口裂开、血清肿、会阴窦或瘘管形成等并发症。术后通过磁共振成像评估皮瓣的存活情况及对缺损闭合的有效性。平均随访时间为20（±9）个月。平均住院时间为8（±2）天。我们没有经历任何皮瓣全部或部分丢失的情况，也没有遇到与伤口相关的任何局部并发症。
埋藏去表皮筋膜皮瓣V-Y推进皮瓣是一种相对简单且省时的手术。它在APR术后闭合骶骨缺损的同时有效填充盆腔死腔，因此减少了与大会阴切除相关的晚期并发症。
