Perrault David, Kin Cindy, Wan Derrick C, Kirilcuk Natalie, Shelton Andrew, Momeni Arash
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Calif.
Section of Colorectal Surgery, Stanford University Medical Center, Palo Alto, Calif.
Plast Reconstr Surg Glob Open. 2020 Apr 24;8(4):e2733. doi: 10.1097/GOX.0000000000002733. eCollection 2020 Apr.
Abdominoperineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author's (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for reconstruction of soft tissue defects following APR and pelvic exenteration.
Patients who underwent pelvic/perineal reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate.
A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49-71 years) and 24.9 kg/m (IQR: 24.2-26.7 kg/m) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn's disease, and 1 (4.3%) with Paget's disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient.
The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/perineal reconstruction.
腹会阴联合切除术（APR）和盆腔脏器清除术仍然是治疗结直肠癌的常用手术。在这些情况下，主要的重建皮瓣一直是腹直肌肌皮瓣。然而，相关供区的并发症不容忽视。在此，我们对文献进行综述，并介绍资深作者（A.M.）使用带蒂股前外侧（ALT）皮瓣重建APR和盆腔脏器清除术后软组织缺损的经验。
本研究纳入了2017年至2019年间接受带蒂ALT皮瓣盆腔/会阴重建的患者。感兴趣的参数包括年龄、性别、体重指数、合并症、放疗史、切除手术范围和术后并发症发生率。
本研究共纳入23例患者（16例男性和7例女性），中位年龄和体重指数分别为66岁（四分位间距[IQR]：49 - 71岁）和24.9kg/m²（IQR：24.2 - 26.7kg/m²）。13例（56.5%）患者为直肠癌，5例（21.7%）为肛管鳞状细胞癌（SCC），4例（17.4%）为克罗恩病，1例（4.3%）为佩吉特病。19例（82.6%）患者接受了新辅助放疗。9例（39.1%）患者出现了11种并发症（2种严重并发症和9种轻微并发症）。最常见的并发症是部分会阴伤口裂开（N = 6 [26.1%]）。除1例患者外，所有患者均实现了稳定的软组织覆盖。
ALT皮瓣可在APR和盆腔脏器清除术后实现稳定的软组织覆盖，且与腹部供区并发症无关。在盆腔/会阴重建中应考虑将其作为一线重建选择。
