title: Reconstruction of the irradiated perineum following extended abdomino-perineal excision for cancer: an algorithmic approach.
abstract: Our unit has implemented an algorithm for irradiated perineal reconstruction incorporating current evidence and a new technique in line with the advent of laparoscopic tumour excision. Our approach attempts to maintain the benefits patients derive from minimally invasive oncological surgery. Four consecutive patients had uterine retroversion to obturate pelvic deadspace and reconstruct the posterior vaginal wall. Age range was 41-84 years and mean follow-up of 21 months with mean in-patient stay of 7 days. All patients had neoadjuvant radiotherapy or chemoradiation for low rectal/anorectal adenocarcinoma. All patients had laparoscopic Extended APER and contiguous posterior vaginal wall excision and reconstruction with uterine retroversion and z-plasty skin closure. One patient required ultrasound aspiration of a pre-sacral seroma at two months. No patients returned to theatre for major complications. We highlight one minor and no major complications associated with an algorithmic approach incorporating our method of uterine retroversion and z-plasty parallel to traditional flap reconstruction methods.
authors: Department of Plastic Surgery, Leeds General Infirmary, Great George St., Leeds, UK. dan_saleh@hotmail.com
authors: D B
authors: DB
authors: Saleh
authors: M I
authors: MI
authors: Liddington
authors: P
authors: P
authors: Loughenbury
authors: C W
authors: CW
authors: Fenn
authors: R
authors: R
authors: Baker
authors: D
authors: D
authors: Burke
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000465:Algorithms; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010502:Perineum / Q000528:radiation effects* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery