Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Canada.
Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Canada.
J Reconstr Microsurg. 2022 Feb;38(2):89-95. doi: 10.1055/s-0041-1729750. Epub 2021 Jun 29.
Pelvic reconstruction with a muscle flap significantly improves postoperative outcomes following abdominoperineal resection (APR). Despite it being the gold standard, significant surgeon-selection bias remains with respect to the necessity of pelvic obliteration, flap choice, and ostomy placement. The objective of the study was to characterize management practices among colorectal surgeons (CSs) and plastic surgeons (PSs).
Specialty-specific surveys were distributed electronically to CSs and PSs via surgical societies. Surveys were designed to illustrate geographic and specialty-specific differences in management.
Of 106 (54 CSs and 52 PSs) respondents (58% Canada, 21% Europe, 14% the United States, and 6% Asia/Africa), significant interdisciplinary differences in practices were observed. Most respondents indicated that multidisciplinary meetings were not performed (74% of CSs and 78% of PSs). For a nonradiated pelvic dead space with small perineal defect, 91% of CSs and 56% of PSs indicated that flap reconstruction was not required. For a radiated pelvic dead space with small perineal defect, only 54% of CSs and 6% of PSs indicated that there was no need for flap reconstruction. With respect to ostomy placement, 87% of CSs and 21% of PSs indicated that stoma placement through the rectus was superior. When two ostomies were required, most CSs preferred exteriorizing ostomies through bilateral recti and requesting thigh-based reconstruction. PSs favored the vertical rectus abdominis muscle (VRAM; 52%) over the gracilis (23%) and inferior gluteal artery perforator (IGAP; 23%) flaps. Among PSs, North Americans favor abdominally based flaps (VRAM 60%), while Europeans favor gluteal-based flaps (IGAP 78%).
A lack of standardization continues to exist with respect to the reconstruction of pelvic defects following APR and pelvic exenteration. Geographic and interdisciplinary biases with respect to ostomy placement, flap choice, and role for pelvic obliteration continues to influence reconstructive practices. These cases should continue to be approached on a case by case basis, driven by pathology, presence of radiation, comorbidities, and the size of the pelvic and perineal defect.
骨盆重建采用肌肉皮瓣可显著改善腹会阴切除术后（APR）的术后结果。尽管它是金标准，但在是否需要骨盆闭塞、皮瓣选择和造口位置方面，仍存在明显的外科医生选择偏倚。本研究的目的是描述结直肠外科医生（CSs）和整形外科医生（PSs）的管理实践。
通过外科协会向 CSs 和 PSs 电子分发专业特定的调查。调查旨在说明管理方面的地域和专业差异。
在 106 名（54 名 CSs 和 52 名 PSs）应答者中（58%来自加拿大，21%来自欧洲，14%来自美国，6%来自亚洲/非洲），观察到跨学科实践存在显著差异。大多数应答者表示没有进行多学科会议（74%的 CSs 和 78%的 PSs）。对于非放射性骨盆死腔伴小会阴缺损，91%的 CSs 和 56%的 PSs 表示不需要皮瓣重建。对于放射性骨盆死腔伴小会阴缺损，只有 54%的 CSs 和 6%的 PSs 表示不需要皮瓣重建。关于造口位置，87%的 CSs 和 21%的 PSs 表示直肠通过优于造口。当需要两个造口时，大多数 CSs 更喜欢通过双侧直肌外置造口，并要求大腿基重建。PSs 更喜欢垂直腹直肌肌皮瓣（VRAM；52%）而不是臀大肌（23%）和臀下动脉穿支皮瓣（IGAP；23%）。在 PSs 中，北美人喜欢基于腹部的皮瓣（VRAM 60%），而欧洲人喜欢基于臀部的皮瓣（IGAP 78%）。
在 APR 和骨盆切除术后面盆缺损的重建方面，仍然缺乏标准化。在造口位置、皮瓣选择和骨盆闭塞作用方面存在地域和跨学科偏见，继续影响重建实践。这些病例应根据病理、放射治疗、合并症以及骨盆和会阴缺损的大小，继续进行具体情况具体分析。
