Reconstruction of the perineum following anorectal cancer excision

Petrie, Nicola; Branagan, Graham; McGuiness, Caroline; McGee, Shaun; Fuller, Clare; Chave, Helen

doi:10.1007/s00384-008-0557-2

Cited by 37 publications

(28 citation statements)

References 36 publications

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“…Mesh was used by Weiwei et al in all five of their reported cases 18 and Petrie et al in 50% of their cases. 11 We experienced minor wound dehiscence in a few cases. This was due to the fact that the flap was exposed to increased pressure and shearing forces from sitting.…”

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confidence: 95%

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

McMenamin

Clements

Edwards

et al. 2011

annals

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INTRODUCTION Perineal wound breakdown with delayed wound healing represents a significant cause of morbidity following surgery and radiotherapy to the perineum. The rectus abdominis myocutaneous (RAM) flap has been used increasingly to reconstruct the perineum with good effect. We describe our six-year experience of reconstruction of the perineum with the RAM flap and share some surgical adjuncts we believe are useful. METHODS We conducted a retrospective case note review of all patients who underwent a reconstruction of the perineum using the RAM flap between August 2003 and October 2009. Indications for the flap, complication rates and outcomes were all observed. RESULTS We conducted 16 RAM flap procedures, 15 of which (94%) were primary repairs and 1 (6%) a secondary repair. Three (19%) developed donor site hernias, two (12.5%) developed minor perineal wound infections, eight (50%) developed minor perineal wound breakdown and in one (6%) flap failure was observed. No perineal hernias were observed. There were no surgical mortalities. CONCLUSIONS The RAM flap has a high success rate and an acceptable morbidity rate and is a useful tool in the reconstruction of complex perineal wounds. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap.

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confidence: 95%

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

McMenamin

Clements

Edwards

et al. 2011

annals

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“…The final stage of the dissection is division of the anterior muscles of the pelvic floor (Fig. Some units prefer to use a muscle flap [1,9], particularly when the perineum has been irradiated [9]. This results in preservation of the neurovascular bundles and an extralevator specimen (Fig.…”

Section: Methods and Resultsmentioning

confidence: 99%

A pictorial description of extralevator abdominoperineal excision for low rectal cancer

et al. 2012

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“…Hurst et al reported a perineal reconstruction for a complicated perineal wound following a proctectomy for Crohn’s disease 2 . Petrie et al demonstrated a significant success rate of 18 cases of flap closure following APR; 3 of these were microvascular transfer of the LD 3 . More recently, the same authors reported a further case using an inferior mesenteric artery stump as the donor vessel 4 .…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report

Kieran

Nugent

Ríordáin

et al. 2012

annals

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Reconstruction of the perineum and pelvic cavity in continuity is an uncommon and difficult challenge. This case describes a 66-year-old man who presented following recurrence of a Dukes’ B rectosigmoid adenocarcinoma that had been treated nine years previously by anterior resection, 5-fluorouracil and radiotherapy. His recurrent disease was treated with radical pelvic exenteration with formation of an end colostomy and urinary ileal conduit.A post-operative pelvic collection necessitated incisional drainage via the perineum. This resulted in a perineal defect in continuity with the pelvic cavity, neither of which healed in spite of alternate day packing with antiseptic dressings. The perineum and cavity were reconstructed successfully with a microvascular transfer of the latissimus dorsi using the primary gracilis pedicle as recipient donor vessels.

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Reconstruction of the perineum following anorectal cancer excision

Abstract: Despite most patients being treated with pre-operative radiotherapy, we have had significant success in obtaining primary healing of the perineal defect after APR.

Cited by 37 publications

References 36 publications

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

A pictorial description of extralevator abdominoperineal excision for low rectal cancer

Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report

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