title: Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis.
abstract: Abdominoperineal resection and pelvic exenteration for resection of malignancies can lead to large perineal defects with significant surgical-site morbidity. Myocutaneous flaps have been proposed in place of primary closure to improve wound healing. A systematic review was conducted to compare primary closure with myocutaneous flap reconstruction of perineal defects following abdominoperineal resection or pelvic exenteration with regard to surgical-site complications.
  
  
  
  A comprehensive literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. After data extraction from included studies, meta-analysis was performed to compare outcome parameters defining surgical-site complications of flap and primary closure.
  
  
  
  Our systematic review yielded 10 eligible studies (one randomized controlled trial and nine retrospective studies) involving 566 patients (226 flaps and 340 primary closures). Eight studies described rectus abdominis myocutaneous flaps and two studies used gracilis flaps. In meta-analysis, primary closure was more than twice as likely to be associated with total perineal wound complications compared with flap closure (OR, 2.17; 95 percent CI, 1.34 to 3.14; p = 0.001). Rates of major perineal wound complications were also significantly higher in the primary closure group (OR, 3.64; 95 percent CI, 1.43 to 7.79; p = 0.005). There was no statistically significant difference between primary and flap closure for minor perineal wound complications, abdominal hernias, length of stay, or reoperation rate.
  
  
  
  This is the first systematic review with meta-analysis comparing primary closure with myocutaneous flap closure for pelvic reconstruction. The authors' results have validated the use of myocutaneous flaps for reducing perineal morbidity following abdominoperineal resection or pelvic exenteration.
  
  
  
  Therapeutic, II.
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Chris
authors.initials: C
authors.lastname: Devulapalli
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Anne Tong
authors.initials: AT
authors.lastname: Jia Wei
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: DiBiagio
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Baez
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Baltodano
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Seal
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Carisa M
authors.initials: CM
authors.lastname: Cooney
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Welch Services Center, William H. Welch Medical Library.
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
mesh_terms: D001005:Anus Neoplasms / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D005834:Genital Neoplasms, Male / Q000601:surgery*; D000071976:Gracilis Muscle / Q000601:surgery; D046449:Hernia, Abdominal / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D064827:Myocutaneous Flap; D010385:Pelvic Exenteration; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures; D017568:Rectus Abdominis / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing