Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon.
OBJECTIVE
Prone cylindrical abdominoperineal resection (APR) leads to reduced circumferential resection margin (CRM) involvement but is associated with a large perineal deficit. A rectus abdominis myocutaneous (RAM) flap can reduce the morbidity associated with the perineal wound. This is often performed in coordination with a plastic surgeon. We reviewed the outcome of prone APR carried out by a single colorectal surgeon using RAM flap without the involvement of plastic surgeons in a district general hospital.


METHODS
Data were reviewed retrospectively for consecutive patients who have undergone prone cylindrical APR and RAM flap reconstruction between 2008 and 2011. Additional data were reviewed for all patients who have undergone supine APR between 2004 and 2008 for comparison.


RESULTS
Twelve patients (seven females, five males) of median age of 69 years (range 50-84 years) underwent prone APR and RAM flap reconstruction. The CRM was negative in all cases. One patient had complete flap necrosis and subsequent flap removal, and three (25 %) patients experienced delayed flap healing. One patient died from bronchopneumonia following a cerebrovascular accident at day 14. In the preceding 4 years, nine patients (three females, six males) of median age of 70 years (range 32-83 years) underwent supine APR alone. The CRM was negative in all cases. Three patients suffered breakdown of the perineal wound requiring prolonged packing, and one developed a methicillin-resistant Staphylococcus aureus wound infection.


CONCLUSIONS
Prone APR and RAM flap reconstruction can be performed by colorectal surgeons in a district general setting with good outcomes, without the need for a plastic surgeon, thus increasing the feasibility of this treatment modality.
Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Greater Manchester, UK.
Jonathan A
JA
Barker
Alexander E
AE
Blackmore
Richard P
RP
Owen
Anthony
A
Rate
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000601:surgery*; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery*; D010820:Physicians; D016684:Prone Position; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000601:surgery*; D017568:Rectus Abdominis / Q000601:surgery*