Myers Paige L, Krasniak Peter J, Day Serena J, Bossert Ronald P
University of Rochester School of Medicine and Dentistry, Rochester, NY.
Ann Plast Surg. 2019 Jun;82(6):667-670. doi: 10.1097/SAP.0000000000001771.
Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity.
A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed.
A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11).
This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.
腹会阴联合切除术是许多肛管直肠恶性肿瘤的治疗方法。剖腹手术入路可获取腹直肌用于会阴重建。然而，随着机器人辅助腹会阴联合切除术的开展数量不断增加，避免了与剖腹手术切口相关的发病率。我们描述了一种对先前技术的改良，即将双侧臀筋膜皮瓣推进盆腔进行重建。该手术在俯卧位快速完成。患者避免了巨大的前部缺损，同时获得了强有力的重建且发病率最低的益处。
对2012年7月至2018年2月我院电子病历数据库进行回顾性图表审查。纳入所有接受改良V-Y臀筋膜皮瓣修复会阴缺损的患者。分析患者的人口统计学、合并症、辅助治疗以及结局和并发症。
共确定31例患者（51个皮瓣），皮瓣存活率为100%。发生轻微并发症的患者总数为42%，包括4例手术部位感染（13%）、13例裂开（42%）和2例需要返回手术室进行脓肿引流（6%）。重要的是，裂开定义为任何伤口分离，无论大小，平均仅3.8厘米。所有患者经保守治疗均愈合。在放弃使用合成网片支撑后，并发症发生率从67%降至37%（优势比，3.4；P = 0.11）。
这种改良的双侧臀筋膜皮瓣V-Y推进技术用于会阴伤口控制是一种安全有效的重建缺损方法。
