Abstract
Background
A major source of morbidity after abdominoperineal resection (APR) after external beam pelvic radiation is perineal wound complications, seen in up to 66% of cases. Our purpose was to determine the effect of rectus abdominus myocutaneous (RAM) flap reconstruction on perineal wound morbidity in this population.
Methods
The study group consisted of 19 patients with anorectal cancer treated with external beam pelvic radiation followed by APR and RAM flap reconstruction of the perineum. A prospectively collected database was queried to identify a control group (n = 59) with anorectal cancer treated with similar radiation doses that subsequently underwent an APR without a RAM flap during the same time period. Comparison of percentages was performed with a two-sided Fisher’s exact test, and comparison of means was performed with Wilcoxon’s test.
Results
Perineal wound complications occurred in 3 (15.8%) of the RAM flap patients and 26 (44.1%) of the control patients (P = .03). The incidence of other complications was not different between groups (42.1% vs. 42.4%; P = .8). Despite an increased number of anal squamous tumors, an increased vaginectomy rate, increased use of intraoperative radiotherapy, and an increased proportion of cases with recurrent disease, the flap group had a significantly lower rate of perineal wound complications relative to the control group.
Conclusions
Perineal closure with a RAM flap significantly decreases the incidence of perineal wound complications in patients undergoing external beam pelvic radiation and APR for anorectal neoplasia. Because other complications are not increased, RAM flap closure of the perineal wound should be strongly considered in this patient population.
Similar content being viewed by others
References
NW Pearlman GV Stiegmann RE Donohue (1989) ArticleTitleExtended resection of fixed rectal cancer Cancer 63 2438–41
PJ Nilsson C Svensson S Goldman B Glimelius (2002) ArticleTitleSalvage abdominoperineal resection in anal epidermoid cancer Br J Surg 89 1425–9
TM Tei T Stolzenburg S Buntzen S Laurberg H Kjeldsen (2003) ArticleTitleUse of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery Br J Surg 90 575–80 Occurrence Handle10.1002/bjs.4073
E Radice H Nelson S Mercill R Farouk P Petty L Gunderson (1999) ArticleTitlePrimary myocutaneous flap closure following resection of locally advanced pelvic malignancies Br J Surg 86 349–54
RG Tompkins AL Warshaw (1985) ArticleTitleImproved management of the perineal wound after proctectomy Ann Surg 202 760–5
JP Anthony SJ Mathes (1990) ArticleTitleThe recalcitrant perineal wound after rectal extirpation. Applications of muscle flap closure Arch Surg 125 1371–6
D Shibata W Hyland P Busse et al. (1999) ArticleTitleImmediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum Ann Surg Oncol 6 33–7 Occurrence Handle1:STN:280:DyaK1M7ltlCrtg%3D%3D Occurrence Handle10030413
WL Baird TR Hester F Nahai J Bostwick SuffixIII (1990) ArticleTitleManagement of perineal wounds following abdominoperineal resection with inferior gluteal flaps Arch Surg 125 1486–9
AK Jain AJ DeFranzo MW Marks BW Loggie S Lentz (1997) ArticleTitleReconstruction of pelvic exenterative wounds with transpelvic rectus abdominis flaps: a case series Ann Plast Surg 38 115–22
N Petrelli L Rosenfield L Herrera A Mittelman (1986) ArticleTitleThe morbidity of perineal wounds following abdominoperineal resection for rectal carcinoma J Surg Oncol 32 138–40 Occurrence Handle1:STN:280:BimB1czitVY%3D Occurrence Handle3736049
J Bostwick SuffixIII J Moore WC McGarity (1988) ArticleTitleInferior gluteal musculocutaneous flap for the obliteration of acute and chronic proctocolectomy defects Surg Gynecol Obstet 166 169–70
JA Ryan SuffixJr. (1984) ArticleTitleGracilis muscle flap for the persistent perineal sinus of inflammatory bowel disease Am J Surg 148 64–70
A Shaw JW Futrell (1978) ArticleTitleCure of chronic perineal sinus with gluteus maximus flap Surg Gynecol Obstet 147 417–20
HJ Wanebo P Antoniuk RJ Koness et al. (1999) ArticleTitlePelvic resection of recurrent rectal cancer: technical considerations and outcomes Dis Colon Rectum 42 1438–48 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyjug%3D%3D Occurrence Handle10566532
JB McCraw FM Massey KD Shanklin CE Horton (1976) ArticleTitleVaginal reconstruction with gracilis myocutaneous flaps Plast Reconstr Surg 58 176–83
R Anderson RB Turnbull SuffixJr. (1976) ArticleTitleGrafting the unhealed perineal wound after coloproctectomy for Crohn disease Arch Surg 111 335–8
EW Buchel S Finical C Johnson (2004) ArticleTitlePelvic reconstruction using vertical rectus abdominis musculocutaneous flaps Ann Plast Surg 52 22–6
SJ Loessin NB Meland RM Devine BG Wolff H Nelson H Zincke (1995) ArticleTitleManagement of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps Dis Colon Rectum 38 940–5
SH Pursell TG Day SuffixJr GR Tobin (1990) ArticleTitleDistally based rectus abdominis flap for reconstruction in radical gynecologic procedures Gynecol Oncol 37 234–8
RC Mixter WA Wood DG Dibbell SuffixSr. (1990) ArticleTitleRetroperitoneal transposition of rectus abdominis myocutaneous flaps to the perineum and back Plast Reconstr Surg 85 437–41
SS Kroll R Pollock JM Jessup D Ota (1989) ArticleTitleTranspelvic rectus abdominis flap reconstruction of defects following abdominal-perineal resection Am Surg 55 632–7
V Giampapa A Keller WW Shaw SR Colen (1984) ArticleTitlePelvic floor reconstruction using the rectus abdominis muscle flap Ann Plast Surg 13 56–9
HS Shukla LE Hughes (1984) ArticleTitleThe rectus abdominis flap for perineal wounds Ann R Coll Surg Engl 66 337–9
PG Cordeiro AL Pusic JJ Disa (2002) ArticleTitleA classification system and reconstructive algorithm for acquired vaginal defects Plast Reconstr Surg 110 1058–65
JM Hoff PM Skibber BD Minsky (2001) Cancer of the rectum VT HS DeVita SA Rosenberg (Eds) Cancer: Principles and Practice of Oncology Lippincott Williams & Wilkins Philadelphia 3235
D Liebermann-Meffert (2000) ArticleTitleThe greater omentum: anatomy, embryology, and surgical applications Surg Clin North Am 80 275–93
B Topor RD Acland V Kolodko S Galandiuk (2001) ArticleTitleOmental transposition for low pelvic anastomoses Am J Surg 182 460–4
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chessin, D.B., Hartley, J., Cohen, A.M. et al. Rectus Flap Reconstruction Decreases Perineal Wound Complications After Pelvic Chemoradiation and Surgery: A Cohort Study. Ann Surg Oncol 12, 104–110 (2005). https://doi.org/10.1245/ASO.2005.03.100
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2005.03.100