Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum.
BACKGROUND
Morbidity associated with a nonhealing perineal wound is the most common complication following proctectomy, particularly in the setting of recurrent carcinoma of the rectum and radiation therapy. Immediate reconstruction using the gracilis myocutaneous and muscle flaps significantly reduces the incidence of major infection associated with perineal wound closure. The purpose of this study was to assess the value of immediate reconstruction of the perineal wound using a gracilis flap in patients undergoing abdominoperineal resection and intraoperative radiation therapy.


METHODS
This study retrospectively reviewed our experience with immediate pelvic reconstruction using gracilis muscle flaps for patients undergoing rectal extirpation and irradiation for recurrent carcinoma of the rectum. From 1990 to 1995, 16 patients underwent abdominoperineal resection (APR) or pelvic exenteration accompanied by immediate wound closure with unilateral or bilateral gracilis muscle flaps. Morbidity and mortality outcomes were compared to those of 24 patients from our institution who, between 1988 and 1992, underwent proctectomy and irradiation for recurrent rectal carcinoma with primary closure of the perineal wound.


RESULTS
Major complications (i.e., major infection requiring hospitalization and/or operation) occurred in 2 (12%) of the patients with gracilis flaps versus 11 (46%) of the patients with primary closure (P = .028 by chi2 analysis for flap vs. primary closure). Minor complications (i.e., persistent sinus and subcutaneous abscess) occurred in 4 (25%) of the patients with gracilis flaps versus 5 (21%) of those with primary closure.


CONCLUSIONS
Immediate perineal reconstruction using the gracilis myocutaneous flap following proctectomy and irradiation for recurrent rectal carcinoma significantly reduces the incidence of major infection associated with perineal wound closure.
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
D
D
Shibata
W
W
Hyland
P
P
Busse
H K
HK
Kim
S M
SM
Sentovich
G
G
Steele
R
R
Bleday
D000005:Abdomen / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery*; D010385:Pelvic Exenteration; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques