University of Florida College of Medicine, Gainesville, Florida.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, Florida.
J Surg Oncol. 2020 Oct;122(5):923-927. doi: 10.1002/jso.26086. Epub 2020 Jun 28.
Following abdominoperineal resection (APR), primary closure of the perineal defect is often possible. Some patients, however, require flap reconstruction. Identifying these patients preoperatively is critical to facilitate comprehensive patient counseling and optimize surgical efficacy.
A retrospective review of patients undergoing APR over a 10-year period was performed to identify predictive factors for patients requiring reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap as opposed to primary closure. Student's t and Fisher's exact tests were utilized for statistical analysis.
A total of 158 patients underwent APR, 29 of whom (18%) required a VRAM flap. A higher average skin resection area was seen among those requiring flap reconstruction (P < .0001). Flap reconstruction was also associated with current smoking status (P = .0197), anal tumor location (P < .0001), and neoadjuvant radiation (P = .0457). Although not statistically significant, average tumor diameter was larger in the VRAM flap group compared with the primary closure group.
While the appropriate method of closure for those undergoing APR should be considered on an individual case basis, patients who smoke, have a tumor located at the anus, or require large skin resection are more likely to need flap reconstruction.
经腹会阴联合切除术（APR）后，会阴缺损通常可直接缝合。但部分患者需要皮瓣重建。术前明确这些患者的情况对于全面的患者咨询和优化手术效果至关重要。
回顾性分析了 10 年间接受 APR 的患者，以确定需要用垂直腹直肌肌皮瓣（VRAM）皮瓣重建而非直接缝合的患者的预测因素。采用 Student's t 检验和 Fisher 确切概率法进行统计学分析。
共 158 例患者接受了 APR，其中 29 例（18%）需要 VRAM 皮瓣。需要皮瓣重建的患者平均皮肤切除面积更大（P<0.0001）。皮瓣重建与当前吸烟状态（P=0.0197）、肛门肿瘤位置（P<0.0001）和新辅助放疗（P=0.0457）相关。尽管无统计学意义，但 VRAM 皮瓣组的平均肿瘤直径大于直接缝合组。
虽然应根据具体情况考虑 APR 患者的合适闭合方法，但吸烟、肿瘤位于肛门或需要大面积皮肤切除的患者更有可能需要皮瓣重建。
