Analysis of clinical and patient-reported outcomes in post-ELAPE perineal reconstruction with IGAP flap – A 5-year review

Pai, Ashwin; YOUNG-SING, Quillan; Bera, Sudipta; MAHESHWARI, Kavish; MISRA, Alok

doi:10.1016/j.jpra.2022.06.002

Cited by 2 publications

(5 citation statements)

References 18 publications

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“…To our knowledge, this is the second largest series describing fasciocutaneous IGAP-based VY flaps for perineal reconstruction in patients that underwent pelvic surgery for malignancy. Our proposal to eliminate extensive dissection of the IGAP perforators simplified the preparation compared to the previous techniques [ 7 , 15 ]. Our results underscored that this could be beneficial for larger defects after ELAPE without compromising the wound healing quality and donor site morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous perineal closure concepts and regional flaps following perineal tumor surgery have been described. Vertical rectus abdominis muscles (VRAM), gracilis muscles with or without skin islands (TUG), gluteus muscle flaps and, more recently, perforator flaps such as the deep inferior epigastric perforator flap (DIEP), profunda artery flap (PAP), and superior or inferior gluteal flap (SGAP or IGAP), have been increasingly described in the literature [ 6 , 7 , 8 , 9 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 ]. The aim of all the flaps is to fill in the pelvic dead space, preventing perineal herniation and bringing well-vascularized tissue into a recipient area almost always altered by pre-irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…Inferior gluteal flaps, such as myocutaneous flaps (IGAMs) for perineal closure, were already described by Baird et al in 1990, one year after Koshima et al described the first ever performed perforator flap [ 26 , 27 ]. In the meantime, a few studies suggested perforator-based IGAP flaps as reliable options for perineal wound closure [ 7 , 15 ]. On the one hand, in 2012, Hainsworth et al first described IGAP flaps (n = 40) as a suitable option for perineal defect coverage, with a relatively low rate of 10% for flap-related major complications and another 10% for minor wound complications.…”

Section: Discussionmentioning

confidence: 99%

“…The resulting perineal defects following resection represent a significant reconstructive challenge. A variety of flaps have been described, mainly using the abdominal, gluteal, and pudendal sites [ 6 , 7 , 8 ]. Of these, abdominal myocutaneous (VRAM) flaps, are most commonly used and are widely reported in the literature [ 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…As an alternative reconstructive strategy addressing the dead space obliteration to prevent the risk of intestinal prolapse with access for patients in a prone jack-knife positioning, perforator-based local flaps of the perineal and gluteal region have been recently introduced in perineal coverage. One of these is the fasciocutaneous gluteal flap, which is based on inferior gluteal artery perforators (IGAPs) [ 7 , 14 , 15 ]. In addition to the oncological indications, perianal fistulous Crohn disease and chronic inflammatory conditions in benign diseases are also possible causes of extralevatoric excisions using the established surgical pathways.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Perineal Defect Reconstruction with Simplified Fasciocutaneous Inferior Gluteal Artery Perforator (IGAP) Flaps after Tumor Resection of the Lower Rectum: Incidence and Outcome in an Interdisciplinary Approach

Thiel,

Welskopf,

Yurttas

et al. 2023

Cancers

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Background: Extralevator abdominoperineal excision (ELAPE) is a relatively new surgical technique for low rectal cancers, enabling a more radical approach than conventional abdominoperineal excision (APE) with a potentially better oncological outcome. To date, no standard exists for reconstruction after extended or extralevator approaches of abdominoperineal (ELAPE) resection for lower gastrointestinal cancer or inflammatory tumors. In the recent literature, techniques with myocutaneous flaps, such as the VY gluteal flap, the pedicled gracilis flap, or the pedicled rectus abdominis flaps (VRAM) are primarily described. We propose a tailored concept with the use of bilateral adipo-fasciocutaneous inferior gluteal artery perforator (IGAP) advancement flaps in VY fashion after ELAPE surgery procedures. This retrospective cohort study analyzes the feasibility of this concept and is, to our knowledge, one of the largest published series of IGAP flaps in the context of primary closure after ELAPE procedures. Methods: In a retrospective cohort analysis, we evaluated all the consecutive patients with rectal resections from Jan 2017 to Sep 2021. All the patients with abdominoperineal resection were included in the study evaluation. The primary endpoint of the study was the proportion of plastic reconstruction and inpatient discharge. Results: Out of a total of 560 patients with rectal resections, 101 consecutive patients with ELAPE met the inclusion criteria and were included in the study evaluation. The primary direct defect closure was performed in 72 patients (71.3%). In 29 patients (28.7%), the defect was closed with primary unilateral or bilateral IGAP flaps in VY fashion. The patients’ mean age was 59.4 years with a range of 25–85 years. In 84 patients, the indication of the operation was lower rectal cancer or anal cancer recurrence, and non-oncological resections were performed in 17 patients. Surgery was performed in a minimally invasive abdominal approach in combination with open perineal extralevatoric abdominoperineal resection (ELAPE) and immediate IGAP flap reconstruction. The rate of perineal early complications after plastic reconstruction was 19.0%, which needed local revision due to local infection. All these interventions were conducted under general anesthesia (Clavien–Dindo IIIb). The mean length of the hospital stay was 14.4 days after ELAPE, ranging from 3 to 53 days. Conclusions: Since radical resection with a broad margin is the standard choice in primary, sphincter-infiltrating rectal cancer and recurrent anal cancer surgery in combination with ELAPE, the choice technique for pelvic floor reconstruction is under debate and there is no consensus. Using IGAP flaps is a reliable, technical, easy, and safe option, especially in wider defects on the pelvic floor with minimal donor site morbidity and an acceptable complication (no flap necrosis) rate. The data for hernia incidence in the long term are not known.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of Perineal Defect Reconstruction with Simplified Fasciocutaneous Inferior Gluteal Artery Perforator (IGAP) Flaps after Tumor Resection of the Lower Rectum: Incidence and Outcome in an Interdisciplinary Approach

Thiel,

Welskopf,

Yurttas

et al. 2023

Cancers

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The Importance of Patient-Reported Outcome Measures (PROMs) in Oncological Vulvoperineal Defect Reconstruction: A Systematic Review

Speck,

Stoffel,

Wendelspiess

et al. 2024

Current Oncology

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Background: Patient-reported outcome measures (PROMs) have gained increased importance in assessing outcomes after reconstructive surgery. This also applies to the reconstruction of vulvoperineal defects after resection of gynecological or colorectal cancers in women. The objective of this study is to analyze the current state of PROM tool use within this patient population. Methods: By systematic literature searches in Embase, Medline, and Web of Science, English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series reporting on vulvoperineal defect reconstruction, which were included if they also analyzed quality of life (QoL) and/or PROMs. The PROM tools used by each study were extracted, analyzed, and compared. Results: The primary search yielded 2576 abstracts, of which 395 articles were retrieved in full text. Of these, 50 reported on vulvoperineal defect reconstruction, among which 27 studies analyzing QoL were found. Of those, 17 met the inclusion criteria for this systematic review. After full-text screening, 14 different PROM tools and 5 individual, non-standardized questionnaires were identified. Only 22% of studies used a validated PROM tool. Conclusion: Far too few studies currently use PROM tools to assess outcomes in oncological vulvoperineal defect reconstruction. Less than half of the used PROMs are validated. No PROM was designed to specifically measure QoL in this patient population. The standardized implementation of a validated PROM tool in the clinical treatment of this patient population is an essential step to improve outcomes, enable the comparison of research, and support evidence-based treatment approaches.

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Analysis of clinical and patient-reported outcomes in post-ELAPE perineal reconstruction with IGAP flap – A 5-year review

Cited by 2 publications

References 18 publications

Feasibility of Perineal Defect Reconstruction with Simplified Fasciocutaneous Inferior Gluteal Artery Perforator (IGAP) Flaps after Tumor Resection of the Lower Rectum: Incidence and Outcome in an Interdisciplinary Approach

Feasibility of Perineal Defect Reconstruction with Simplified Fasciocutaneous Inferior Gluteal Artery Perforator (IGAP) Flaps after Tumor Resection of the Lower Rectum: Incidence and Outcome in an Interdisciplinary Approach

The Importance of Patient-Reported Outcome Measures (PROMs) in Oncological Vulvoperineal Defect Reconstruction: A Systematic Review

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