title: Abdominal- versus thigh-based reconstruction of perineal defects in patients with cancer.
abstract: BACKGROUND
  An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned.
  
  
  OBJECTIVE
  We report a single surgeon's experience with perineal reconstruction in patients with cancer with the use of either the vertical rectus abdominus myocutaneous flap or the anterolateral thigh flap to demonstrate acceptable outcomes with either repair modality.
  
  
  METHODS
  From 2010 to 2012, 19 consecutive patients with perineal defects secondary to cancer underwent flap reconstruction. A retrospective chart review of prospectively entered data was conducted to determine the frequency of short-term and long-term complications.
  
  
  METHODS
  This study was conducted at an academic, tertiary-care cancer center.
  
  
  METHODS
  Patients in the study were patients with cancer who were receiving perineal reconstruction.
  
  
  METHODS
  Interventions were surgical and included either abdomen- or thigh-based reconstruction.
  
  
  METHODS
  The main outcome measures included infection, flap failure, length of stay, and time to radiotherapy.
  
  
  RESULTS
  Of the 19 patients included in our study, 10 underwent anterolateral thigh flaps and 9 underwent vertical rectus abdominus myocutaneous flaps for reconstruction. There were no significant differences in demographics between groups (p > 0.05). Surgical outcomes and complications demonstrated no significant differences in the rate of infection, hematoma, bleeding, or necrosis. The mean length of stay after reconstruction was 9.7 ± 3.4 days (± SD) in the anterolateral thigh flap group and 13.4 ± 7.7 days in the vertical rectus abdominus myocutaneous flap group (p > 0.05).
  
  
  CONCLUSIONS
  The limitations of this study include a relatively small sample size and retrospective evaluation.
  
  
  CONCLUSIONS
  This study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).
authors.affiliation: 1The Department of Plastic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 2The Department of General Surgery, Division of Colon and Rectal Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Pang
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.forename: Jens
authors.initials: J
authors.lastname: Berli
authors.forename: Kate
authors.initials: K
authors.lastname: Buretta
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Rochlin
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Efron
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000628:therapy; D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000628:therapy; D005260:Female; D006085:Graft Survival; D006547:Hernia / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000637:transplantation; D010502:Perineum / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013848:Thigh / Q000601:surgery*; D014945:Wound Healing