An Algorithmic Approach to Perineal Reconstruction After Cancer Resection—Experience From Two International Centers

Abstract

Although various surgeons performed the reconstructive surgeries at 2 different centers, the essential approach remained the same. Smaller defects were best treated by local flaps, whereas the rectus abdominis flap remained the standard option for larger defects that additionally required closure of dead space. On the basis of our 2 center experience, we propose a simple algorithm to facilitate the planning of reconstructive surgery for the perineum.

Posterior perineal reconstructions with “supra-fascial” lotus petal flaps

“…20,21 Indeed, recent publications have highlighted the benefit of perforator flaps for pelviperineal reconstructions. 22,23 The posteriorly rotated lotus petal flap is presented as the ideal solution for small or medium defects in the area, but few specific clinical series have been published to date.…”

Trends and Complications of Vulvar Reconstruction After Vulvectomy: A Study of a Nationwide Cohort

“…The decision to reconstruct or not often requires consideration of factors such as size of the defect, prior surgeries or radiation, and preexisting medical conditions. Although a variety of algorithms have been proposed to assist surgeons in this decision, 31,32 there is currently no consensus on optimal selection of patients for reconstruction. This is likely owing to the low incidence of vulvar and other pelvic malignancies and subsequent lack of large-scale analysis of the utilization and surgical outcomes of reconstruction in comparison to primary closure.…”

“…7,13Y30 Several algorithmic approaches have been developed to help surgeons determine when to use reconstructive surgery after vulvar cancer excision. John et al 31 proposed an algorithm based on location and size of defect to determine the best form of closure. Mericili et al 32 described another algorithm based on location and depth of defect, bilaterality, and availability of flap material.…”

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

“…Salvage surgery carries significant risks of mortality and morbidity with up to 45% of patients developing a significant complication, including delayed perineal healing for greater than 3 months [80]. For this reason, perineal reconstruction using autologous tissue may be required using methods such as rectus abdominis myocutaneous flaps, gluteal flaps, gracilis flaps or free latissimus dorsi flaps [82], which may reduce wound breakdown rates in the heavily irradiated tissues [83,84]. Salvage surgery can achieve 5-year survival ranging from 29 to 75% [81,83,[85][86][87].…”