Alvandipour Mina, Sayyadi Sohrab, Samarghandi Nasibeh, Khodabakhsh Asal, Mortazavi Milani Atousa, Najafi Mohammad Javad
Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
J Gastrointest Cancer. 2025 Jul 24;56(1):163. doi: 10.1007/s12029-025-01289-7.
Perineal wound complications after abdominoperineal resection (APR) for low rectal cancer remain a significant challenge. Effective reconstruction methods are critical to reducing morbidity and improving outcomes.
To compare the effectiveness of primary closure versus Limberg flap reconstruction in managing perineal defects post-abdominoperineal resection.
Sixty patients undergoing APR for rectal cancer were randomized into two groups. Fifty-four patients completed the study and were analyzed (26 in the primary closure group and 28 in the Limberg flap group). Baseline characteristics, including mean age, gender distribution, cancer stage, and neoadjuvant chemoradiation status, were recorded. Primary outcomes included uncomplicated wound healing, while secondary outcomes assessed complications, wound healing time, and hospital stay. Statistical significance was set at p < 0.05.
The average age of the participants was 68.04 ± 11.50 years, with an average weight of 74.42 ± 12.47 kg and a mean Body Mass Index (BMI) of 27.31 ± 3.90 kg/m. Males comprised 57.4% of the sample, 38.9% of whom had diabetes, and nearly 80% underwent neoadjuvant chemoradiation therapy. The Limberg flap group exhibited significantly lower complication rates (17.9% compared to 42.3%, p = 0.02), reduced wound healing times (6.14 ± 2.07 days compared to 8.12 ± 4.01 days, p = 0.03), and shorter hospitalization durations (7.68 ± 2.96 days compared to 11.35 ± 6.27 days, p = 0.008). Among diabetic patients in the primary closure cohort, there are significant differences in the rates of complications, infections, and wound dehiscence (p < 0.02, p < 0.02, p < 0.01, respectively).
Limberg flap reconstruction offers superior outcomes compared to primary closure for perineal reconstruction following APR.
低位直肠癌经腹会阴联合切除术（APR）后会阴伤口并发症仍然是一项重大挑战。有效的重建方法对于降低发病率和改善预后至关重要。
比较一期缝合与菱形皮瓣重建术在经腹会阴联合切除术后处理会阴缺损方面的有效性。
60例行直肠癌APR的患者被随机分为两组。54例患者完成研究并进行分析（一期缝合组26例，菱形皮瓣组28例）。记录基线特征，包括平均年龄、性别分布、癌症分期和新辅助放化疗情况。主要结局包括伤口顺利愈合，次要结局评估并发症、伤口愈合时间和住院时间。设定统计学显著性为p < 0.05。
参与者的平均年龄为68.04 ± 11.50岁，平均体重为74.42 ± 12.47 kg，平均体重指数（BMI）为27.31 ± 3.90 kg/m²。男性占样本的57.4%，其中38.9%患有糖尿病，近80%接受了新辅助放化疗。菱形皮瓣组的并发症发生率显著较低（分别为17.9%和42.3%，p = 0.02），伤口愈合时间缩短（分别为6.14 ± 2.07天和8.12 ± 4.01天，p = 0.03），住院时间缩短（分别为7.６8 ± 2.96天和1１.35 ± 6.27天，p = 0.008）。在一期缝合队列中的糖尿病患者中，并发症、感染和伤口裂开的发生率存在显著差异（分别为p < 0.02，p < 0.02，p < 0.01）。
与一期缝合相比，菱形皮瓣重建术在经腹会阴联合切除术后会阴重建方面具有更好的效果。
