Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection.
BACKGROUND
Significant morbidity can result from perineal wounds, particularly after radiotherapy and extensive resection for cancer. Myocutaneous flaps have been used to improve healing. The purpose of this study was to evaluate the morbidity and results of primary rectus abdominis myocutaneous flap reconstruction of the vagina and perineum after extended abdominoperineal resection.


METHODS
Thirty-one consecutive patients undergoing one-stage rectus abdominis myocutaneous flap reconstruction of extensive perineal wounds were studied prospectively. Twenty-six patients had surgery for recurrent or persistent epidermoid anal cancer or low rectal cancer, and 21 had high-dose preoperative radiotherapy.


RESULTS
Three weeks after the operation, complete healing of the perineal wound was seen in 27 of the 31 patients. There were nine flap-related complications including three patients with partial flap necrosis, two with vaginal stenosis, one with vaginal scarring, one with small flap disunion and two with weakness of the anterior abdominal wall. There were no unhealed wounds at the completion of follow-up (median 9 months).


CONCLUSIONS
The transpelvic rectus abdominis myocutaneous flap for the reconstruction of large perineal and vaginal wounds achieves wound healing with only moderate morbidity in the majority of patients after extensive abdominoperineal resection with or without radiotherapy.
Bell
S W
SW
Centre de Chirurgie Digestive, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 75571 Paris, France.
Dehni
N
N
Chaouat
M
M
Lifante
J C
JC
Parc
R
R
Tiret
E
E
D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010502:Perineum / Q000528:radiation effects / Q000601:surgery*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D017568:Rectus Abdominis / Q000637:transplantation*; D012086:Reoperation; D013524:Surgical Flaps; D014621:Vagina / Q000528:radiation effects / Q000601:surgery*; D014945:Wound Healing