John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom.
Department of Plastic Surgery, Cleveland Clinic Foundation, Ohio.
Dis Colon Rectum. 2022 Nov 1;65(11):1316-1324. doi: 10.1097/DCR.0000000000002271. Epub 2021 Dec 13.
Flap-based reconstruction following abdominoperineal resection has been used to address the resultant soft tissue defect and reduce postoperative wound complications. Vertical rectus abdominis myocutaneous flaps have been the traditional choice, but locoregional flaps have attracted attention in minimally invasive resection because they avoid additional abdominal dissection. However, few data exist comparing flap types.
To compare outcomes for different types of perineal reconstruction in patients undergoing abdominoperineal resection exclusively for anorectal pathology.
This was a retrospective comparative study.
This study was conducted at a large, tertiary referral institution.
Following Institutional Review Board approval, prospectively maintained clinical and financial databases were interrogated and cross-referenced for patients undergoing proctectomy or abdominoperineal resection with flap reconstruction from 2007 to 2018. Patients with primary gynecological or urological pathology were excluded.
The primary outcome was flap complication rate. Secondary outcomes included perineal hernia rate, donor site complications, emergency department consult after discharge, readmission <90 days, and length of stay. Data were analyzed using univariate and multivariate techniques.
A total of 135 patients (79 female, median age 58 years) were included: 68 rectus, 52 gluteal, and 15 gracilis flap reconstructions. Median follow-up was 46 months. Rates of both major and minor flap complications were similar for rectus and gluteal flaps, even when controlling for differences between groups via multivariate analysis ( p > 0.9), including extent of resection and use of mesh. For all flaps, American Society of Anesthesiology score ≥3 was the only independent predictor of major, but not minor, flap complications. For rectus and gluteal flaps, smoking, female sex, and American Society of Anesthesiology score ≥3 were independent predictors of major flap complications ( p < 0.05).
This study was limited by its retrospective nature and potential selection bias associated with flap choice; it was also impossible to quantify defect size.
Gluteal flaps have similar complication rates to rectus flaps and may be considered for patients who are otherwise suitable for minimally invasive abdominoperineal resection. See Video Abstract at http://links.lww.com/DCR/B866 .Una comparación de los colgajos miocutáneos perineales después de la escisión abdominoperineal del recto para patología anorectal.
La reconstrucción con colgajo después de la resección abdominoperineal se ha utilizado para abordar el defecto de tejido blando resultante y reducir las complicaciones postoperatorias de la herida. Los colgajos miocutáneos verticales del recto abdominal han sido la elección tradicional, pero los colgajos locorregionales han atraído la atención en la resección mínimamente invasiva porque evitan la disección abdominal adicional. Sin embargo, existen pocos datos que comparen los tipos de colgajos.
采用基于皮瓣的重建来处理腹会阴切除术后的软组织缺损，减少术后伤口并发症。垂直腹直肌肌皮瓣一直是传统的选择，但局部皮瓣在微创切除中引起了关注，因为它们避免了额外的腹部解剖。然而，比较皮瓣类型的数据很少。
比较专门用于肛肠病理的腹会阴切除术后不同类型会阴重建的结果。
这是一项回顾性比较研究。
这项研究在一家大型的三级转诊机构进行。
经机构审查委员会批准，从 2007 年至 2018 年，前瞻性维护的临床和财务数据库被查询和交叉引用，以寻找接受直肠切除术或腹会阴切除术并进行皮瓣重建的患者。排除有原发性妇科或泌尿科疾病的患者。
主要结局是皮瓣并发症发生率。次要结局包括会阴疝发生率、供区并发症、出院后急诊就诊、90 天内再入院和住院时间。使用单变量和多变量技术分析数据。
共纳入 135 例患者（79 例女性，中位年龄 58 岁）：68 例腹直肌皮瓣，52 例臀肌皮瓣，15 例股薄肌皮瓣重建。中位随访时间为 46 个月。腹直肌皮瓣和臀肌皮瓣的主要和次要皮瓣并发症发生率相似，即使通过多变量分析控制组间差异（p>0.9），包括切除范围和使用网片。对于所有皮瓣，美国麻醉医师协会评分≥3 是主要皮瓣并发症的唯一独立预测因素，但不是次要皮瓣并发症的独立预测因素（p>0.9）。对于腹直肌皮瓣和臀肌皮瓣，吸烟、女性、美国麻醉医师协会评分≥3 是主要皮瓣并发症的独立预测因素（p<0.05）。
本研究受限于其回顾性性质和皮瓣选择相关的潜在选择偏倚；也无法量化缺陷大小。
臀肌皮瓣的并发症发生率与腹直肌皮瓣相似，对于适合微创腹会阴切除术的患者，可以考虑使用臀肌皮瓣。[参见视频摘要，网址：http://links.lww.com/DCR/B866]
