Reconstruction techniques after extralevator abdominoperineal rectal excision or pelvic exenteration: meshes, plasties and flaps.

Autores de IIS La Fe

• 

  Matteo Frasson

  Autor

• Blas Flor Lorente

  Autor

• Omar Carreño Saenz

  Autor

Abstract

Perineal wound complications after abdomino-perineal rectal resection are frequent and clinically relevant for their impact on the length of hospitalization, costs, patients' quality of life and oncologic results. With the diffusion of the preoperative radiotherapy and the gradual shift to the extra-elevator technique, the perineal morbidity rate has increased. Many series describing different techniques of primary closure of the perineal defect have been published, but high-quality clinical studies, indicating which is the best option, are missing. A biologic mesh, associated if possible to an omentoplasty, seems to be sufficient to close the perineal defect after extra-elevator abdomino-perineal rectal resection. However, when the proctectomy is associated to the resection of other organs, as for example vagina or sacrum, resulting in an ample perineal defect, the vertical rectus abdominis flap seems to be the best option. If the perineal defect is smaller, the gracilis or gluteus flaps could be other valid alternatives.

Keywords

• Abdomino-perineal rectal resection; Amputacion abdominoperineal del; Cierre con malla; Cierre directo; Colgajo miocutaneo; Colgajo musculo recto; Cancer del recto bajo; Epiploplastia; Herida perineal; Hernia perineal; Low rectal cancer; Myocutaneous flap; Perineal hernia; Perineal wound; Primary closure; recto