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Outcomes of Perineal Flap Reconstruction Following Abdominoperineal Excision of the Rectum: A Large Single-Institution Experience
T Leavitt, JP Tiernan, A Jarrar, R Isakov, MA Valente, SR Steele, CP Delaney, E Gorgun
Cleveland Clinic Foundation - Department of Plastic Surgery
2018-02-10
Presenter: Tripp Leavitt
Affidavit:
This is a collaborative project with the Department of Colorectal Surgery with which the resident has been thoroughly involved. These findings have not previously been published or presented.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Several options, including the vertical rectus abdominis myocutaneous (VRAM), gluteal thigh, and gracilis flaps, are available when reconstructing perineal defects following abdominoperineal excision of the rectum (APER). This study examined the outcomes of all patients undergoing flap reconstruction following APER at our institution over the 12 years.
Methods: Patients who underwent perineal flap reconstruction between 2005-2017 following APER for anorectal disease were studied. Patients with primary gynecological or urological malignancy were excluded. Univariate and multivariate statistical analyses were performed using SPSS software.
Results: One-hundred-eighteen patients underwent reconstruction with either VRAM (n=56), gluteal thigh (n=49), or gracilis (n=12) flaps . APER was performed for rectal cancer (n=69), anal cancer (n=36), other malignancies (n=2), benign disease (n=4) and inflammatory bowel disease (n=7). American Society of Anesthesiologists (ASA) Class above III was the only independent predictor of major, but not minor, complications. Compared to VRAM flaps, gluteal flaps were associated with fewer vaginectomies (18.4 vs 33.3%, p=0.081), greater use of perineal biological mesh (20.4 vs 1.8%, p=0.002) and increased utilization of laparoscopic or robotic surgical techniques (28.6 vs 3.5%, p<0.0001). Rates of major and minor flap complications were similar across VRAM and gluteal flap groups (10.2 vs 10.5% and 34.7 vs 35.1% respectively). Gracilis flaps were associated with a greater number of major flap complications than gluteal flaps (p=0.043).
Conclusion: ASA Class above III was the only independent predictor of major flap complications. Gluteal flaps demonstrate similar complication rates to VRAM flaps, with particular utility following minimally invasive APER, although further prospective evaluation is justified.
