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Implementation of a "No Sitting" Protocol following V-Y Fasciocutaneous Flap Closure of Abdominoperineal Resections
Ian L. McCulloch, MRes
Cody L. Mullens, BS
Mihail Climov, MD
Vidas Dumasius, MD
Nezar Jrebi, MD
West Virginia University School of Medicine
2019-02-15
Presenter: Ian McCulloch
Affidavit:
I certify that this work is original and has not been published or presented elsewhere
Director Name: Aaron Mason
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Anorectal malignancy is commonly treated surgically with an abdominoperineal resection (APR). Wound complications, most commonly dehiscence, may occur in up to 66% of primary closures likely due to increased tension and pressure at the perineum. Recent reports suggest APRs closed using V-Y fasciocutaneous flaps may incur less overall complication. The purpose of this study was to examine the efficacy of V-Y closure following APR when coupled with a strict "no-sitting" protocol.
Methods: Retrospective analysis of all patients closed via V-Y flap following APR between 2015 and 2018 was conducted. Included patients did not sit on the closure for six weeks with gradually increased sitting time thereafter.
Results: 20 patients were included (11 men, 9 women). Average BMI was 29.89. Fourteen were former long term smokers, nineteen had either hypertension, diabetes, or cardiovascular disease. Average hospital course was 8 days with two readmissions within sixty days for wound complications. Five (25%) patients developed abscesses, one developed seroma (5%), and two dehisced (10%). No case resulted in intraoperative complications conferred by either the colorectal or plastic surgeons.
Conclusions: Our results demonstrate that the V-Y flap closure of APR is a safe method with less complication that reported rates for primary closure. Further our no-sitting protocol which relieves tension and pressure on the wound may lead to less wound dehiscence. Further our use of a multidisciplinary team, including a plastic surgeon for closure may confer better outcomes. Further study will compare our institutions complication rates for APRs with primary closure.
