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Long-term Outcomes of Single-stage Vertical Rectus Abdominus Myocutaneous Flap Reconstruction following Abdominoperineal Resection for Advanced Inflammatory Bowel Disease with Complex Perineal Involve
Elad Fraiman, Vikas S. Kotha MD, Thriaksh Rajan, Raymond Isakov, MD
Cleveland Clinic
2025-01-10
Presenter: Elad Fraiman
Affidavit:
Elad Fraiman
Director Name: Raymond Isakov
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Abdominoperineal resection (APR) for advanced inflammatory bowel disease (IBD) poses challenges in managing perineal defects. IBD patients face increased risks of postoperative complications, including wound dehiscence, fistula formation, and infection, due to immunosuppression and chronic inflammation. Vertical rectus abdominis myocutaneous (VRAM) flaps provide sufficient tissue volume for large defect reconstruction but carry risks of donor site morbidity. This study compares long-term outcomes of VRAM flap reconstruction with alternatives like gracilis and gluteal thigh flaps in IBD patients undergoing APR.
Methods:
This retrospective review analyzed 19 IBD patients undergoing myocutaneous flap reconstruction after APR (2012–2021). Data included demographics, IBD type, comorbidities, flap type, complications, healing time, and follow-up. Outcomes assessed were donor site complications, perineal wound complications, and hospital stay. Statistical analysis was descriptive due to the small sample size.
Results:
Among 19 patients (mean age 43.24, BMI 21.80), 68.4% had Crohn's disease. Surgical indications included gastrointestinal malignancy (52.6%) and fistulizing disease (36.8%). VRAM was most common (73.7%), followed by gracilis (21.1%) and gluteal thigh (5.3%) flaps. VRAM complications included non-healing wounds (28%) and abdominal bulge (7.1%), with minor perineal wound complications in 57.1% compared to 25% for gracilis flaps. No total flap loss occurred. Two VRAM patients (10%) required reoperation for presacral fluid collections. Median healing time was 120 days, longest for gluteal thigh flaps.
Conclusion:
VRAM flap reconstruction following APR for IBD provides a reliable option for managing complex perineal defects. Exhibiting minimal donor site morbidity, VRAM flaps demonstrate favorable outcomes with low recurrence of fistulizing disease.
