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Wide Propeller Posterior Thigh Flap to Reconstruct Perineal Defects post Abdominoperineal Resection
Carlos Ordenana MD
Edoardo Dalla Pozza MD
Sayf Said MD
Francis Papay MD
Hermann Kessler MD PhD
Antonio Rampazzo MD
Bahar Bassiri MD PhD
Cleveland Clinic
2018-02-01
Presenter: Carlos Ordenana
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Carlos Ordenana has made the majority of this work in conjunction with Edoardo Dalla Pozza.
Director Name: Bahar Bassiri
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Introduction:
With increasing popularity of laparoscopic and robotic approaches to colectomy during abdominoperineal resection (APR), thigh based flaps are becoming the only option for reconstruction of the perineal defect. Among these the Posterior Thigh Flap (PTF) has historically fallen short of Vertical Rectus Abdominis Muscle (VRAM) flap due to a higher complication rate (43.7% vs 35.8) with wound dehiscence caused by critical distal vascularization being the most common (5-29.9%).
Methods:
Anatomic dissections were conducted on 14 gluteal and posterior thigh regions. The course and distribution of Inferior Gluteal Artery (IGA), descending branch of IGA, Profunda Femoris Artery (PFA) and perforators directed to the flap was recorded and mapped.
A Wide Propeller Posterior Thigh Flap (WPTF) including the width of the thigh was designed and nine patients underwent reconstruction of the perineal defect following APR with the WPTF.
Results:
The descending branch of the IGA was present in 10 specimens (71.4%), with an average caliber of 2.3±0.2mm. In 4 (28.6%) specimens the main arterial axis of the flap derived from PFA with a main caliber of 2±0.5mm. All flaps survived. In two cases the flap was based on the first PFA perforator.
Conclusions:
The descending branch of the IGA is absent in a significant number of patients. In these cases, elevation of a narrow flap can cause distal flap necrosis. Implementation of the propeller design and routine harvest of a wide flap that includes the perforators from PFA can increase the survival and versatility of the flap.
