title: Perineal flap reconstruction following oncologic anorectal extirpation: an outcomes assessment.
abstract: BACKGROUND
  The poorly healing perineal wound is a significant complication of abdominoperineal resection. The authors examined criteria for immediate flap coverage of the perineum and long-term cross-sectional surgical outcomes.
  
  
  METHODS
  Patients who underwent abdominoperineal resection or pelvic exenteration for anorectal cancer were retrospectively analyzed. Demographic characteristics, premorbid and oncologic data, surgical treatment, reconstruction method, and recovery were recorded. Outcomes of successful wound healing, surgical complications necessitating intervention (admission or return to the operating room), and progression to chronic wounds were assessed.
  
  
  RESULTS
  The authors identified 214 patients who underwent this procedure from 1995 to 2013. Forty-seven patients received pedicled flaps and had higher rates of recurrence and reoperation, active smoking, Crohn disease, human immunodeficiency virus, and anal cancers, and had higher American Joint Committee on Cancer tumor stages. Thirty-day complication rates were equivalent in the two groups. There were no complete flap losses or reconstructive failures. Perineal wound complication rates were marginally but not significantly higher in the flap group (55 percent versus 41 percent; p = 0.088). Infectious complications, readmissions for antibiotics, and operative revision were more frequent in the flap cohort. A larger proportion of the primary closure cohort developed chronic draining perineal wounds (23.3 versus 8.5 percent; p = 0.025).
  
  
  CONCLUSIONS
  Immediate flap coverage of the perineum was less likely to progress to a chronic draining wound, but had higher local infectious complication rates. The authors attribute this to increased comorbidity in the selected patient population, reflecting the surgical decision making in approaching these high-risk closures and ascertainment bias in diagnosis of infectious complications with multidisciplinary examination.
  
  
  METHODS
  Risk, III.
authors.affiliation: San Francisco, Calif. From the Divisions of Plastic and Reconstructive Surgery and Colorectal Surgery, University of California, San Francisco.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wang
authors.forename: Nicole
authors.initials: N
authors.lastname: Conkling
authors.forename: Xiaoti
authors.initials: X
authors.lastname: Xu
authors.forename: Hueylan
authors.initials: H
authors.lastname: Chern
authors.forename: Emily
authors.initials: E
authors.lastname: Finlayson
authors.forename: Madhulika G
authors.initials: MG
authors.lastname: Varma
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hansen
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foster
authors.forename: William Y
authors.initials: WY
authors.lastname: Hoffman
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
mesh_terms: D001005:Anus Neoplasms / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps