Predictable closure of the abdominoperineal resection defect: a novel two-team approach

Journal of the American College of Surgeons
Peter B ArnoldJohn B McCraw

Abstract

Primary closure of the perineum at the time of abdominoperineal resection (APR) is seldom successful. Several factors are known to adversely affect healing, including neoadjuvant chemoradiation, tension, contamination, and fluid collection. This study evaluates a 2-team approach for resection and routine perineal closure in a single stage. After tumor resection, the abdominal and perineal closures are performed simultaneously by 2 separate teams. A competent closure of the perineal defect is achieved with bilateral V-to-Y inferior gluteal artery perforator fasciocutaneous flaps (BIGAP) mobilizing buttock skin, fat, and gluteal muscle fascia for inset into the defect. No muscle is elevated with the flaps and no attempt is made to obliterate the deepest aspects of the pelvic defect. Beginning in August 2010, 18 consecutive patients who underwent APR for distal rectal (n = 14) and anal carcinoma (n = 4) were included in the study. All patients had received neoadjuvant chemoradiation therapy. Primary healing was achieved in 16 of 18 patients with a completely tension-free closure. One patient required debridement and secondary closure. Another patient had an unresectable tumor, which invaded the flap closure. Minor healing problems...Continue Reading

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Citations

Nov 20, 2012·Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India·Ramesh K Sharma, Atul Parashar
Nov 21, 2012·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·M J MarshallI R Daniels
Jun 5, 2018·International Wound Journal·Caitlin CahillLara J Williams
Oct 25, 2017·Plastic and Reconstructive Surgery. Global Open·Kasandra R DassoulasChris A Campbell
May 23, 2020·Plastic and Reconstructive Surgery. Global Open·David PerraultArash Momeni
Dec 30, 2014·Plastic and Reconstructive Surgery·Eric D WangHani Sbitany
Oct 9, 2020·Microsurgery·Carlos OrdenanaBahar Bassiri Gharb
Dec 1, 2021·Plastic and Reconstructive Surgery·Christie BialowasAshit Patel

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