Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
J Gastrointest Surg. 2024 Jan;28(1):57-63. doi: 10.1016/j.gassur.2023.11.006.
High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus on the ideal flap choice or patient for whom this is necessary. This study aimed to evaluate the long-term outcomes of using pedicled gracilis flaps for pelvic reconstruction and to analyze predictors of postoperative complications.
This was a retrospective review of a single reconstructive surgeon's cases between January 2012 and June 2021 identifying patients who underwent perineal reconstruction secondary to oncologic resection. Preoperative and outcome variables were collected and analyzed to determine the risk of developing minor and major wound complications.
A total of 101 patients were included in the study with most patients (n = 88) undergoing unilateral gracilis flap reconstruction after oncologic resection. The mean follow-up period was 75 months. Of 101 patients, 8 (7.9%) developed early major complications, and an additional 13 (12.9%) developed late major complications. Minor complications developed in 33 patients (32.7%) with most cases being minor wound breakdown requiring local wound care. Most patients (n = 92, 91.1%) did not develop donor site complications. Anal cancer was significantly associated with early major complications, whereas younger age and elevated body mass index were significant predictors of developing minor wound complications.
This study builds on our previous work that demonstrated the long-term success rate of gracilis flap reconstruction after large pelvic oncologic resections. A few patients developed donor site complications, and perineal complications were usually easily managed with local wound care, thus making the gracilis flap an attractive alternative to abdominal-based flaps.
接受腹会阴联合切除术和盆腔脏器切除术的高危患者可能受益于即刻皮瓣重建。然而，目前对于理想的皮瓣选择或哪些患者需要进行重建尚未达成共识。本研究旨在评估使用带蒂股薄肌皮瓣进行盆腔重建的长期结果，并分析术后并发症的预测因素。
这是对单一位重建外科医生在 2012 年 1 月至 2021 年 6 月期间的病例进行的回顾性研究，确定了因肿瘤切除而行会阴重建的患者。收集并分析了术前和术后变量，以确定发生轻微和严重伤口并发症的风险。
共有 101 例患者纳入研究，其中大多数患者（n=88）在肿瘤切除后接受单侧股薄肌皮瓣重建。平均随访时间为 75 个月。在 101 例患者中，8 例（7.9%）发生早期严重并发症，另外 13 例（12.9%）发生晚期严重并发症。33 例（32.7%）发生轻微并发症，多数为需要局部伤口护理的轻微伤口破裂。大多数患者（n=92，91.1%）未发生供区并发症。肛门癌与早期严重并发症显著相关，而年龄较小和体重指数升高是发生轻微伤口并发症的显著预测因素。
本研究扩展了我们之前的工作，证明了股薄肌皮瓣在大型盆腔肿瘤切除后重建的长期成功率。少数患者发生供区并发症，会阴并发症通常通过局部伤口护理即可轻松处理，因此股薄肌皮瓣是腹部皮瓣的一种有吸引力的替代选择。
