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Comparison of Outcomes of the Standard Posterior Thigh Flap Versus Modified Wide Propeller Posterior Thigh Flap for Perineal Reconstruction following Abdominoperineal Resection.
Sayf Said, Joan Lee, Hermann Kessler, Armand Lucas, Antonio Rampazzo, Bahar Bassiri Gharb
Cleveland Clinic, Department of Plastic Surgery
2019-02-14
Presenter: Sayf Al-deen Said, MD
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.
Director Name: Bahar Bassiri Gharb, MD, PhD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
With increasing popularity of laparoscopic and robotic approaches to colectomy during abdominoperineal resection (APR), thigh-based flaps are becoming the only option for perineal reconstruction. The standard posterior thigh flap (SPTF) has historically been associated with a high complication rate mainly caused by critical distal vascularization. This study aimed to assess outcomes of perineal reconstruction with a Wide-propeller PTF (WPTF) designed to include the perforators of profunda femoris to improve flap vascularity and compare them against SPTF.
Method:
IRB-approved retrospective review was conducted including patients who received a PTF post-APR. Patients' demographics, comorbidities, smoking status, prior pelvic and abdominal surgeries, ASA level, chemoradiation; APR indication, approach, perineal defect size; flap timing post APR, laterality, size; donor site closure; length of hospital stay, time to ambulation, complications and secondary procedures were recorded. Non-parametric univariate analysis and logistic regression multivariable analysis were conducted.
Results:
Thirty-three patients were identified (22 SPTF, 12 WPTF). Bilateral SPTF were required in 4 patients in SPTF group versus none in WPTF group (P=.403). Partial graft necrosis occurred in 18.2% SPTF vs 0% in WPTF (P=.403). Recipient site complications developed in 70% SPTF and 27.3% WPTF (P=.054). Wound dehiscence occurred in 40% of SPTF versus none in WPTF (P=.072). There were less donor site complications (9.1% WPTF versus 15% SPTF, P=.792), readmissions and reoperations (18.2% versus 45.0%, P=.227) following WPTF. Adjusted Odds Ratio of developing overall complication in WPTF was 0.002 compared to the SPTF (P=.012).
Conclusions:
Modification of the flap design improved flap reliability and overall outcomes.
