title: Transabdominal-pelvic-perineal (TAPP) anterolateral thigh flap: A new reconstructive technique for complex defects following extended abdominoperineal resection.
abstract: BACKGROUND
  Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study.
  
  
  METHODS
  Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT + VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed.
  
  
  RESULTS
  Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits.
  
  
  CONCLUSIONS
  The use of the ALT + VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address: pietro.di-summa@chuv.ch.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: di Summa
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: Maurice
authors.initials: M
authors.lastname: Matter
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bauquis
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
authors.forename: Wassim
authors.initials: W
authors.lastname: Raffoul
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply* / Q000637:transplantation*; D061646:Operative Time; D010385:Pelvic Exenteration / Q000379:methods / Q000523:psychology; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013848:Thigh / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
keywords: Abdominoperineal resection; Anterolateral thigh flap; Anteroposterior defects; Total pelvic exenteration; Transabdominal