Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
J Plast Reconstr Aesthet Surg. 2019 Apr;72(4):565-571. doi: 10.1016/j.bjps.2018.12.044. Epub 2019 Jan 9.
Pelvic reconstruction following abdominoperineal resection or pelvic exenteration is associated with signification surgical site morbidity. Immediate pelvic reconstruction with a muscle flap is now the gold standard, associated with reduced perineal morbidity compared to primary closure alone. The purpose of the present study was to directly compare outcomes of VRAM and gracilis flap pelvic reconstruction following oncologic resection.
A multicenter retrospective review was performed of 88 patients who underwent abdominoperineal resection or pelvic exenteration and immediate pelvic reconstruction, either with a VRAM (N = 61) or Gracilis flap (N = 27). Electronic medical records were analyzed for patient demographics, intraoperative data, and postoperative outcomes. Mortality, minor complication rate, major complication rate and time to complete wound healing was compared between groups.
Overall, there was no significant difference in the minor complication rate (44% gracilis vs 48% VRAM, p = 0.8), major complication rate (19% gracilis vs 13% of VRAM, p = 0.53), 30-day mortality (0% VRAM vs 0% gracilis, p = 1.0) and median time to complete wound healing (68 days vs 67 days, p = 0.19) between the gracilis and VRAM groups. Muscle-only gracilis flaps had a significantly reduced healing time compared to musculocutaneous gracilis flaps (48 days vs 85 days, p = 0.007).
The workhorse flap in pelvic reconstruction remains the VRAM. While previous studies have alluded to the inferiority of thigh based flaps compared to the VRAM, we demonstrate here that pelvic reconstruction with the gracilis flap can be performed with comparable donor and recipient complication rates and similar time to complete wound healing as the VRAM.
腹会阴联合切除术或盆腔脏器切除术（APR/PE）后进行盆底重建会导致明显的手术部位并发症。目前，即刻使用肌皮瓣进行盆底重建已成为金标准，与单纯一期缝合相比，会阴并发症发生率更低。本研究旨在直接比较 VRAM 和股薄肌皮瓣在肿瘤切除术后盆底重建的效果。
对 88 例行 APR/PE 并即刻行盆底重建的患者进行多中心回顾性分析，重建方式为 VRAM（n=61）或股薄肌皮瓣（n=27）。分析电子病历中的患者人口统计学资料、术中数据和术后结果。比较两组患者的死亡率、轻微并发症发生率、严重并发症发生率和完全愈合时间。
总体而言，两组患者的轻微并发症发生率（44%股薄肌 vs 48%VRAM，p=0.8）、严重并发症发生率（19%股薄肌 vs 13%VRAM，p=0.53）、30 天死亡率（0%VRAM vs 0%股薄肌，p=1.0）和完全愈合时间中位数（68 天 vs 67 天，p=0.19）差异均无统计学意义。单纯股薄肌肌瓣的愈合时间明显短于股薄肌肌皮瓣（48 天 vs 85 天，p=0.007）。
在盆底重建中，VRAM 仍然是主力皮瓣。虽然之前的研究表明股部皮瓣的效果不如 VRAM，但我们在此证明，使用股薄肌皮瓣进行盆底重建，其供区和受区并发症发生率与 VRAM 相似，完全愈合时间也相似。
