title: Recent experience with abdominal perineal resection with vertical rectus abdominis myocutaneous flap reconstruction after preoperative pelvic radiation.
abstract: Abdominoperineal resection (APR) after pelvic radiation can be complicated by an increased rate of difficult to treat perineal wound complications. In an effort to improve postoperative morbidity after APR, myocutaneous flap reconstructions have been used. We review our recent experience with APR with vertical rectus abdominis myocutaneous flap reconstruction (VRAM) after preoperative pelvic radiation. A retrospective review of patients who underwent APR with VRAM reconstruction after pelvic radiation from December 2004 to July 2008 was conducted. Outcome measures included demographics, comorbidities, length of stay, wound complications, and morbidity and mortality. Fifteen patients with a mean age of 61 +/- 9 years underwent APR with VRAM reconstruction. Five patients also required posterior vaginectomy with the APR. Indications for APR were rectal cancer (n = 14, 93%) and anal canal cancer (n = 1, 7%). There were no intraoperative complications. Mean estimated blood loss was 635 +/- 446 mL and mean intraoperative blood transfusion requirements were 1 +/- 2 units. Mean length of hospital stay was 11 +/- 4 days. Six (40%) patients had minor perineal wound complications. One (7%) patient had a perineal wound infection requiring reoperation with washout and reapproximation. There was no 30-day or in-hospital mortality. All VRAM flaps remained viable through follow-up. APR with VRAM flap reconstruction after preoperative pelvic radiation can be performed safely with limited wound complications and no mortality.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA.
authors.forename: Marcelo W
authors.initials: MW
authors.lastname: Hinojosa
authors.forename: Dhavan A
authors.initials: DA
authors.lastname: Parikh
authors.forename: Raman
authors.initials: R
authors.lastname: Menon
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D010502:Perineum / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D017568:Rectus Abdominis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome