Fellow in the department of plastic and reconstructive, university of Montreal hospital center (CHUM), 1000, rue Saint-Denis H2X 0C1, Montreal, Quebec, Canada.
Plastic surgeon in the plastic and reconstructive surgery department, university of Montreal hospital center (CHUM), 1000, rue Saint-Denis H2X 0C1, Montreal, Canada.
Ann Chir Plast Esthet. 2022 Sep;67(4):224-231. doi: 10.1016/j.anplas.2022.06.001. Epub 2022 Jun 27.
Abdominoperineal resection (APR) of low rectal and anal tumors are performed for optimal oncological outcome but results in large defects in the perineum. Although vertical rectus abdominus (VRAM) flap is commonly employed for extensive perineal reconstruction, donor site morbidity remains problematic. The fascio-cutaneous "lotus petal" flap is an appealing option for reconstructing perineal defects as it may benefit from less donor site morbidity than other techniques. The purpose of this study is to demonstrate that the lotus flap should not only be limited to small and moderate sized defects, but can also be applied to extensive APR.
A systematic review of the literature on the outcomes and dimensions of the lotus flap was performed. Articles with clear anatomical landmarks and internal pudendal artery flaps dimensions were identified. Afterwards, the lotus flap technique was applied on a series of patients with extensive perineal defects following APR treated in our center.
Four articles on internal pudendal artery perforator flap were selected. The average reported size of this flap was 13cm×6cm. In our center, reconstruction of the perineum with oversized lotus flaps was performed on 10 consecutive patients. None had partial/complete flap loss or donor-site morbidity. The use of a Jack-Knife surgical position, indocyanide green fluorescence imaging, and preservation of a proximal skin bridge can extend the size of a secure flap to up to 20cm in length.
The oversized lotus flap is a reliable option for reconstruction after extensive APR.
为了获得最佳的肿瘤学效果，低位直肠和肛门肿瘤需要进行腹会阴联合切除术（APR），但这会导致会阴部位出现较大的缺陷。虽然垂直腹直肌皮瓣（VRAM）常用于广泛的会阴重建，但供区并发症仍然是一个问题。筋膜皮瓣“莲花瓣”是重建会阴缺陷的一种有吸引力的选择，因为它可能比其他技术具有更少的供区并发症。本研究的目的是证明莲花瓣不仅应限于小和中等大小的缺陷，还可以应用于广泛的 APR。
对文献中关于莲花瓣的结果和尺寸的系统评价进行了检索。确定了有明确解剖标志和阴部内动脉皮瓣尺寸的文章。然后，我们在中心应用莲花瓣技术对一系列接受广泛 APR 治疗的会阴有大面积缺陷的患者进行治疗。
选择了 4 篇关于阴部内动脉穿支皮瓣的文章。该皮瓣的平均报告尺寸为 13cm×6cm。在我们中心，10 例连续接受 APR 治疗的患者采用超大莲花瓣进行会阴重建。无部分/完全瓣坏死或供区并发症。使用 Jack-Knife 手术体位、吲哚菁绿荧光成像和保留近端皮桥可以将安全瓣的尺寸延长至 20cm 长。
超大莲花瓣是广泛 APR 后重建的可靠选择。
