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Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer

BACKGROUND: Abdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel g...

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Autores principales: Blok, R. D., Hagemans, J. A. W., Burger, J. W. A., Rothbarth, J., van der Bilt, J. D. W., Lapid, O., Hompes, R., Tanis, P. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736901/
https://www.ncbi.nlm.nih.gov/pubmed/31432332
http://dx.doi.org/10.1007/s10151-019-02055-1
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author Blok, R. D.
Hagemans, J. A. W.
Burger, J. W. A.
Rothbarth, J.
van der Bilt, J. D. W.
Lapid, O.
Hompes, R.
Tanis, P. J.
author_facet Blok, R. D.
Hagemans, J. A. W.
Burger, J. W. A.
Rothbarth, J.
van der Bilt, J. D. W.
Lapid, O.
Hompes, R.
Tanis, P. J.
author_sort Blok, R. D.
collection PubMed
description BACKGROUND: Abdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel gluteal turnover flap (GT-flap) without donor site scar for perineal closure after APR. METHODS: Consecutive patients who underwent APR for primary or recurrent rectal cancer were included in a prospective non-randomised pilot study in two academic centres. Perineal reconstruction consisted of a unilateral subcutaneous GT-flap, followed by midline closure. Feasibility was defined as uncomplicated perineal wound healing at 30 days in at least five patients, and a maximum of two flap failures. RESULTS: Out of 17 potentially eligible patients, 10 patients underwent APR with GT-flap-assisted perineal wound closure. Seven patients had pre-operative radiotherapy. Median-added theatre time was 38 min (range 35–44 min). Two patients developed a superficial perineal wound dehiscence, most likely because of the excessive width of the skin island. Two other patients developed purulent discharge and excessive serosanguinous discharge, respectively, resulting in four complicated wounds at 30 days. No flap failure occurred, and no radiological or surgical reinterventions were performed. Median length of hospital stay was 10 days (IQR 8–12 days). CONCLUSIONS: The GT-flap for routine perineal wound closure after APR seems feasible with limited additional theatre time, but success seems to depend on correct planning of the width of the flap. The potential for reducing perineal morbidity should be evaluated in a randomised controlled trial. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10151-019-02055-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-67369012019-09-23 Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer Blok, R. D. Hagemans, J. A. W. Burger, J. W. A. Rothbarth, J. van der Bilt, J. D. W. Lapid, O. Hompes, R. Tanis, P. J. Tech Coloproctol Original Article BACKGROUND: Abdominoperineal resection (APR) carries a high risk of perineal wound morbidity. Perineal wound closure using autologous tissue flaps has been shown to be advantageous, but there is no consensus as to the optimal method. The aim of this study was to evaluate the feasibility of a novel gluteal turnover flap (GT-flap) without donor site scar for perineal closure after APR. METHODS: Consecutive patients who underwent APR for primary or recurrent rectal cancer were included in a prospective non-randomised pilot study in two academic centres. Perineal reconstruction consisted of a unilateral subcutaneous GT-flap, followed by midline closure. Feasibility was defined as uncomplicated perineal wound healing at 30 days in at least five patients, and a maximum of two flap failures. RESULTS: Out of 17 potentially eligible patients, 10 patients underwent APR with GT-flap-assisted perineal wound closure. Seven patients had pre-operative radiotherapy. Median-added theatre time was 38 min (range 35–44 min). Two patients developed a superficial perineal wound dehiscence, most likely because of the excessive width of the skin island. Two other patients developed purulent discharge and excessive serosanguinous discharge, respectively, resulting in four complicated wounds at 30 days. No flap failure occurred, and no radiological or surgical reinterventions were performed. Median length of hospital stay was 10 days (IQR 8–12 days). CONCLUSIONS: The GT-flap for routine perineal wound closure after APR seems feasible with limited additional theatre time, but success seems to depend on correct planning of the width of the flap. The potential for reducing perineal morbidity should be evaluated in a randomised controlled trial. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10151-019-02055-1) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-08-20 2019 /pmc/articles/PMC6736901/ /pubmed/31432332 http://dx.doi.org/10.1007/s10151-019-02055-1 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Blok, R. D.
Hagemans, J. A. W.
Burger, J. W. A.
Rothbarth, J.
van der Bilt, J. D. W.
Lapid, O.
Hompes, R.
Tanis, P. J.
Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title_full Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title_fullStr Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title_full_unstemmed Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title_short Feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
title_sort feasibility of a subcutaneous gluteal turnover flap without donor site scar for perineal closure after abdominoperineal resection for rectal cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736901/
https://www.ncbi.nlm.nih.gov/pubmed/31432332
http://dx.doi.org/10.1007/s10151-019-02055-1
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