Chasapi Maria, Maher Mohamed, Mitchell Peter, Dalal Milind
From the Plastic Surgery Department, Royal Preston Hospital, Sharoe Green Lane North, Preston, Lancashire PR2 9HT, UK.
Ann Plast Surg. 2018 Apr;80(4):395-399. doi: 10.1097/SAP.0000000000001267.
Extralevator abdominoperineal excision (ELAPE) is increasingly used to treat locally advanced low rectal cancer as it has been related to superior oncological outcomes than traditional abdominoperineal excision.However, ELAPE also has been associated with high perineal wound morbidity rates as it creates a larger perineal cavity than standard abdominoperineal excision. This greater defect, along with the effects of preoperative chemoradiation on wound healing, makes uneventful perineal reconstruction post-ELAPE a real challenge for the plastic surgeon.In this paper, the authors present a new technique for perineal reconstruction post-ELAPE, using a perforator, islanded, turnover, de-epithelialized local flap (perineal turnover perforator [PTO] flap).
The PTO flap is raised based on perforators from internal pudendal artery. The flap is based on the concept that thick gluteal dermis can act as an "autologous dermal vascularized" substitute for the excised pelvic floor muscles, whereas the bulk of its subcutaneous tissue is used to obliterate dead space.Fourteen patients underwent perineal reconstruction using this approach. Patients' demographics, neoadjuvant chemoradiotherapy, histopathology, duration of surgery, follow-up, and complications were analysed retrospectively.
Median operating time was 49 minutes. There were no flap, donor site, or major wound complications. One patient had superficial skin dehiscence, and one patient developed perineal hernia. None of the patients developed chronic perineal pain.
The PTO flap is a quick, simple yet safe and reliable option for perineal reconstruction after ELAPE that offers many advantages over the heretofore used reconstructive techniques including primary closure, myocutaneous flaps, and biological meshes.
经肛提肌腹会阴联合切除术（ELAPE）越来越多地用于治疗局部晚期低位直肠癌，因为与传统的腹会阴联合切除术相比，它具有更好的肿瘤学结局。然而，ELAPE也与较高的会阴伤口发病率相关，因为它比标准的腹会阴联合切除术形成更大的会阴腔隙。这种更大的缺损，加上术前放化疗对伤口愈合的影响，使得ELAPE术后顺利进行会阴重建对整形外科医生来说是一项真正的挑战。在本文中，作者介绍了一种ELAPE术后会阴重建的新技术，即使用穿支岛状翻转去上皮局部皮瓣（会阴翻转穿支皮瓣[PTO皮瓣]）。
PTO皮瓣基于阴部内动脉的穿支进行掀起。该皮瓣的设计理念是，厚实的臀区真皮可作为切除盆底肌肉的“自体带血管化真皮”替代物，而其大部分皮下组织用于消除死腔。14例患者采用该方法进行会阴重建。对患者的人口统计学资料、新辅助放化疗、组织病理学、手术时间、随访情况及并发症进行回顾性分析。
中位手术时间为49分钟。未出现皮瓣、供区或严重伤口并发症。1例患者出现浅表皮肤裂开，1例患者发生会阴疝。所有患者均未出现慢性会阴疼痛。
PTO皮瓣是ELAPE术后会阴重建的一种快速、简单且安全可靠的选择，与以往使用的重建技术（包括一期缝合、肌皮瓣和生物补片）相比具有许多优势。
