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Improving Outcomes Using Aesthetic Body Lifting Principles in Posterior Trunk and Perineal Wound Reconstruction

Marco A. Swanson MD, Corinne Wee MD, Erika N. Ghazoul BS, Christina Kerner BS, Anand R. Kumar MD, Tobias Long MD
Case Western / University Hospitals
2020-02-15

Presenter: Marco Swanson

Affidavit:
All the work on this project represents the original work of the resident.

Director Name: Edward Davidson MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

Background
Optimal aesthetic posterior trunk and perineal wound reconstruction remains understudied. Due to the unique location and geometry, these wounds are at high risk of infection, dehiscence and recurrence. We hypothesize that local fasciocutaneous flaps designed on well accepted body contouring markings will 1) improve aesthetic outcomes and 2) decrease wound complications. The aim of our study is to evaluate the efficacy and safety of our novel treatment protocol.

Methods
A retrospective study was performed in patients who underwent posterior trunk and perineal reconstruction using our aesthetic principle protocol. Variables assessed included patient healing risk factors, wound characteristics, visual analog score pre and post intervention and complications.

Results
10 (7 male, 3 female) patients were identified. Wound etiologies were pressure (7), pilonidal cyst (1), hidradenitis (1) and trauma (1). Average wound area was 113 cm2 (33-300 cm¬2). Primary complication predictor variables were smoker (5), paralysis/insensate (4), diabetes (1) and protective fecal diversion (1). Mean follow-up was 3 (1-6) months. Minor superficial dehiscence (<1cm) occurred in 3 patients and major complication requiring re-advancement and conversion to myocutaneous flap occurred in 1 non-compliant patient. No infections occurred. Visual analog score ratings were 1.6±0.8 pre-reconstruction and 6.1±3.0 post-reconstruction (p<0.0001).

Conclusion
Using natural anatomic boundaries and aesthetic body contouring principles, posterior trunk and perineal reconstruction resulted in improved perceptional outcome scores and low complication despite of this inherently high risk patient population and the large fasciocutaneous flap designs. Future study will evaluate large cohorts and surgical technique refinements to further decrease complication rates.

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