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Immediate Flap Reconstruction following Abdominoperineal Resection for Fistulizing Inflammatory Bowel Disease and IBD-related Oncologic Pathologies: A Single-Surgeon, Tertiary Care Longitudinal Experi
Elad Fraiman BS, Vikas S. Kotha MD, Scott R. Steele, MD, Raymond Isakov MD
Cleveland Clinic Foundation
2024-02-01
Presenter: Vikas Kotha, MD
Affidavit:
100% original work of the resident
Director Name: Raymond Isakov
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Hallmarks of advanced IBD include multiple intestinal resections, GI-vaginoperineal fistula, and chronic pelvic fluid collections, all of which promote complication following APR closure. This study aims to investigate longterm fidelity of muscle flap reconstruction of perineal defects in patients with sequelae of advanced IBD.
Methodology:
A retrospective observational study of consecutive cases performed between 1/1/2010-1/1/2022 by the senior author was conducted. Eligibility criteria included age >18 and history of IBD with fistulizing disease complications or secondary GI malignancy requiring APR and immediate flap reconstruction.
Results:
Nineteen consecutive patients were included (mean age 43yo). APR with immediate reconstruction was indicated for fistulizing IBD in 9 patients and IBD-related malignancy in 10 patients. All oncologic patients had undergone neoadjuvant radiation. Seven (37%) had failed prior Jpouch. Five (26%) had chronic preop pelvic fluid collections.
Immediate reconstruction was with VRAM (n=14), gracillis (n=4), and gluteal thigh flap (n=1). 11 VRAMs (78.6%) were myocutaneous, all with inlay macroporous low-weight mesh.
Mean follow-up was 265d. No flap loss nor complications requiring reoperation occurred. Ten (53%) patients developed nonoperative perineal flap wounds. Two (10.5%) patients developed postoperative presacral fluid collections. Mean time to full perineal healing was 115d. 1 VRAM patient developed abdominal bulge that did not evolve to operable hernia.
Conclusions:
Immediate rectus muscle reconstruction confers successful perineal healing and mitigates chronic pelvic-perineal complications after APR in patients with advanced IBD who often require serial resective procedures as part of chronic disease treatment.
