title: Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: a cohort study.
abstract: BACKGROUND
  A major source of morbidity after abdominoperineal resection (APR) after external beam pelvic radiation is perineal wound complications, seen in up to 66% of cases. Our purpose was to determine the effect of rectus abdominus myocutaneous (RAM) flap reconstruction on perineal wound morbidity in this population.
  
  
  METHODS
  The study group consisted of 19 patients with anorectal cancer treated with external beam pelvic radiation followed by APR and RAM flap reconstruction of the perineum. A prospectively collected database was queried to identify a control group (n = 59) with anorectal cancer treated with similar radiation doses that subsequently underwent an APR without a RAM flap during the same time period. Comparison of percentages was performed with a two-sided Fisher's exact test, and comparison of means was performed with Wilcoxon's test.
  
  
  RESULTS
  Perineal wound complications occurred in 3 (15.8%) of the RAM flap patients and 26 (44.1%) of the control patients (P = .03). The incidence of other complications was not different between groups (42.1% vs. 42.4%; P = .8). Despite an increased number of anal squamous tumors, an increased vaginectomy rate, increased use of intraoperative radiotherapy, and an increased proportion of cases with recurrent disease, the flap group had a significantly lower rate of perineal wound complications relative to the control group.
  
  
  CONCLUSIONS
  Perineal closure with a RAM flap significantly decreases the incidence of perineal wound complications in patients undergoing external beam pelvic radiation and APR for anorectal neoplasia. Because other complications are not increased, RAM flap closure of the perineal wound should be strongly considered in this patient population.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Chessin
authors.forename: John
authors.initials: J
authors.lastname: Hartley
authors.forename: Alfred M
authors.initials: AM
authors.lastname: Cohen
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
authors.forename: Peter
authors.initials: P
authors.lastname: Cordeiro
authors.forename: Joseph
authors.initials: J
authors.lastname: Disa
authors.forename: Babek
authors.initials: B
authors.lastname: Mehrara
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Philip
authors.initials: P
authors.lastname: Paty
authors.forename: Martin
authors.initials: M
authors.lastname: Weiser
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Wong
authors.forename: Jose G
authors.initials: JG
authors.lastname: Guillem
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration; D010502:Perineum; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D017568:Rectus Abdominis / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents