Comparison Of Bilateral Gluteal Artery Perforator Flaps To Vertical Rectus Abdominis Musculocutaneous Flaps In Reconstruction Of Perineal Wounds
Katherine C. Benedict, MD1, Somjade J. Songcharoen, MD1, Kristen L. Stephens, MD2, Shelley R. Edwards, BS1, Anna L. Winter, BS1, Christopher A. Campbell, MD2, Peter B. Arnold, MD, PhD1.
1University of Mississippi Medical Center, Jackson, MS, USA, 2University of Virginia, Charlottesville, VA, USA.
PURPOSE: Achieving a healed perineal wound following chemoradiotherapy and abdominoperineal resection (APR) is challenging for surgeons and patients. Prior studies have shown trunk-based flaps; including vertical rectus abdominis myocutaneous flaps (VRAM), are superior to both primary closure and thigh-based flaps, however there has been no direct comparison to gluteal fasciocutaneous flaps. This study evaluates postoperative complications after various methods of perineal flap closure of APR and pelvic exenteration defects.
METHODS: Retrospective review of patients who underwent APR or pelvic exenteration from April 2008-September 2020 was analyzed for postoperative complications. Flap closure techniques including VRAM, unilateral (IGAP), and bilateral (BIGAP) inferior gluteal artery perforator fasciocutaneous flaps were compared.
RESULTS: 116 patients were included, majority underwent fasciocutaneous (BIGAP/IGAP) flap reconstruction (n=69, 59.6%), followed by VRAM (n=47, 40.5%). There were no significant differences between group patient demographics, comorbidities, BMI, or cancer stage. There were no significant differences between BIGAP/IGAP and VRAM groups in minor complications (57% versus 49%, p=0.426) or major complications (45% versus 36%, p=0.351) including major/minor perineal wounds. BIGAP/IGAP group had shorter length of stay compared to VRAM group, this did not reach significance (10.81 versus 16.89 days, p=.120).
CONCLUSION: Prior studies have shown flap closure is superior to primary perineal closure after neoadjuvant radiation, but lack consensus on which flap offers superior post-operative morbidity. This study comparing outcomes of perineal flap closure showed no significant difference in post-operative complication rates. Fasciocutaneous flaps are an excellent choice for perineal reconstruction due to their ease of elevation and low donor site morbidity.
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