title: Predictable closure of the abdominoperineal resection defect: a novel two-team approach.
abstract: BACKGROUND
  Primary closure of the perineum at the time of abdominoperineal resection (APR) is seldom successful. Several factors are known to adversely affect healing, including neoadjuvant chemoradiation, tension, contamination, and fluid collection. This study evaluates a 2-team approach for resection and routine perineal closure in a single stage.
  
  
  METHODS
  After tumor resection, the abdominal and perineal closures are performed simultaneously by 2 separate teams. A competent closure of the perineal defect is achieved with bilateral V-to-Y inferior gluteal artery perforator fasciocutaneous flaps (BIGAP) mobilizing buttock skin, fat, and gluteal muscle fascia for inset into the defect. No muscle is elevated with the flaps and no attempt is made to obliterate the deepest aspects of the pelvic defect.
  
  
  RESULTS
  Beginning in August 2010, 18 consecutive patients who underwent APR for distal rectal (n = 14) and anal carcinoma (n = 4) were included in the study. All patients had received neoadjuvant chemoradiation therapy. Primary healing was achieved in 16 of 18 patients with a completely tension-free closure. One patient required debridement and secondary closure. Another patient had an unresectable tumor, which invaded the flap closure. Minor healing problems were seen in 7 patients.
  
  
  CONCLUSIONS
  BIGAP flaps provide sufficient tissue to predictably provide primary closure of the perineal defect. Perineal wound healing morbidity is dramatically reduced compared with primary simple closure of this defect. Early results indicate that this method of perineal closure offers a straightforward and predictable method that is comparable in efficacy to other methods using pedicled flaps for perineal closure.
authors.affiliation: Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA. parnold@umc.edu
authors.forename: Peter B
authors.initials: PB
authors.lastname: Arnold
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lahr
authors.forename: Marc E
authors.initials: ME
authors.lastname: Mitchell
authors.forename: James L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Nancy
authors.initials: N
authors.lastname: Salloum
authors.forename: Micah R
authors.initials: MR
authors.lastname: Walker
authors.forename: Sana L
authors.initials: SL
authors.lastname: Bhatti
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Powers
authors.forename: John B
authors.initials: JB
authors.lastname: McCraw
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing