Bercz Aron, Alvarez Janet, Rosen Roni, Drescher Matthew, Sonoda Hiroyuki, Karagkounis Georgios, Wei Iris, Widmar Maria, Nash Garrett M, Weiser Martin R, Paty Philip B, Allen Robert J, Nelson Jonas A, Coriddi Michelle, Dayan Joseph H, McCarthy Colleen, Shahzad Farooq, Matros Evan, Disa Joseph J, Cordeiro Peter G, Mehrara Babak J, Garcia-Aguilar Julio, Smith J Joshua, Pappou Emmanouil P
Department of Surgery, Colorectal Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Surgery, Plastic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf065.
Perineal wound management after radical pelvic surgery is complex and diverse. This retrospective study evaluated surgical morbidity and predictors of wound complications associated with different perineal closure techniques.
Medical records of patients who underwent abdominoperineal resection or pelvic exenteration followed by tissue flap reconstruction (TFR) or primary closure (PC) between 2012 and 2020 were reviewed. Postoperative morbidity, including wound dehiscence, infection, flap loss, and Clavien-Dindo complications, were assessed.
In all, 414 patients underwent surgery for rectal (364) or anal (50) malignancies, with 150 receiving TFR and 264 receiving PC; an omental flap was used in 81 patients who underwent PC. TFR was more commonly used in complex situations (for example exenteration, sacrectomy, vaginectomy, intraoperative radiation). Compared with PC, TFR was associated with higher 90-day rates of wound dehiscence (27 versus 11%; P < 0.001), wound infection (25 versus 14%; P < 0.001) and grade ≥III Clavien-Dindo complications (32 versus 17%; P = 0.001). Flap loss occurred in 2 patients (1%) who underwent TFR. No differences were observed among TFR subtypes, or between patients who underwent PC with and without an omental flap. Multivariate analysis demonstrated that anal cancer (odds ratio (OR) 5.24, 95% confidence interval (c.i.) 1.07 to 25.58; P = 0.041) and extralevator resection (OR 3.09, 95% c.i. 1.07 to 8.92; P = 0.037) were independent predictors of wound dehiscence, whereas vaginectomy was a predictor of wound dehiscence in the TFR subgroup (OR 17.9, 95% c.i. 1.05 to 304.73; P = 0.046).
TFR was associated with higher morbidity due to greater case complexity, but there were no difference in outcomes across flap subtypes. Anal cancer, extralevator resection, and vaginectomy were independent predictors of dehiscence. Omental flaps did not increase the risk of wound complications.
根治性盆腔手术后的会阴伤口处理复杂多样。本回顾性研究评估了与不同会阴闭合技术相关的手术发病率及伤口并发症的预测因素。
回顾了2012年至2020年间接受腹会阴联合切除术或盆腔脏器清除术并随后进行组织瓣重建（TFR）或一期缝合（PC）的患者的病历。评估术后发病率，包括伤口裂开、感染、皮瓣坏死和Clavien-Dindo并发症。
共有414例患者因直肠（364例）或肛门（50例）恶性肿瘤接受手术，其中150例接受TFR，264例接受PC；81例行PC的患者使用了网膜瓣。TFR更常用于复杂情况（如盆腔脏器清除术、骶骨切除术、阴道切除术、术中放疗）。与PC相比，TFR术后90天伤口裂开率（27%对11%；P<0.001）、伤口感染率（25%对14%；P<0.001）和≥III级Clavien-Dindo并发症发生率（32%对17%；P=0.001）更高。2例行TFR的患者（1%）出现皮瓣坏死。TFR各亚型之间，以及行PC的患者中使用和未使用网膜瓣的患者之间均未观察到差异。多因素分析表明，肛管癌（比值比（OR）5.24，95%置信区间（c.i.）1.07至25.58；P=0.041）和肛提肌外切除术（OR 3.09，95% c.i. 1.07至8.92；P=0.037）是伤口裂开的独立预测因素，而阴道切除术是TFR亚组中伤口裂开的预测因素（OR 17.9，95% c.i. 1.05至304.73；P=0.046）。
由于病例复杂性更高，TFR与更高的发病率相关，但各皮瓣亚型的结局无差异。肛管癌、肛提肌外切除术和阴道切除术是伤口裂开的独立预测因素。网膜瓣未增加伤口并发症风险。
