Transpelvic Oblique Rectus Abdominis Myocutaneous Flap With Preservation of the Rectus Sheath.
Abdominal Oblique Muscles
/ transplantation
Adult
Anus Neoplasms
/ surgery
Carcinoma, Squamous Cell
/ surgery
Chemoradiotherapy
Female
Humans
Laparoscopy
/ methods
Myocutaneous Flap
/ transplantation
Neoplasm, Residual
Perineum
/ surgery
Proctectomy
/ methods
Plastic Surgery Procedures
/ methods
Rectus Abdominis
/ transplantation
Vagina
/ surgery
Journal
Diseases of the colon and rectum
ISSN: 1530-0358
Titre abrégé: Dis Colon Rectum
Pays: United States
ID NLM: 0372764
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
entrez:
20
11
2020
pubmed:
21
11
2020
medline:
22
12
2020
Statut:
ppublish
Résumé
Perineal reconstructive surgery is an effective procedure to decrease the morbidity associated with extensive abdominoperineal resection in the treatment of advanced low rectal and anal malignancies. Rectus abdominis myocutaneous flaps are often utilized in perineal reconstruction with excellent results. However, the main disadvantages are donor-site morbidity and the need for an open procedure after laparoscopic resection, requiring larger incisions with a resultant increase in postoperative pain. Herein, we describe a modified oblique rectus abdominis myocutaneous flap technique that allows sparing of the rectus sheath and the linea alba. We followed the 3 stages regularly described for the procedure: 1) abdominoperineal resection with simultaneous abdominal and perineal team approach, and removal of the specimen through the perineal wound; 2) right oblique rectus abdominis myocutaneous flap with inferior epigastric pedicle, and release of the rectus muscle from its aponeurotic sheath through the skin paddle incision and transposition of the oblique rectus abdominis myocutaneous flap through an incision in the transversalis fascia; and 3) perineal reconstruction by sutures of the skin paddle to the perineal wound skin edges. Release of the rectus muscle within its sheath through the incision in the skin paddle turned out to be a simple surgical procedure, without the need of specialized surgical instruments or additional incisions. There were no complications during the postoperative recovery. Our patient was pain-free 1 month after the surgery, with a well-healed flap and abdominal scar. Performance of an oblique rectus abdominis myocutaneous flap that is specifically fitted for the perineal defect after abdominoperineal resection, with muscle dissection performed through the skin paddle incision and transposition into the pelvis through the transversalis fascia, offers good functional outcome while minimizing damage to the abdominal wall.
Sections du résumé
BACKGROUND
Perineal reconstructive surgery is an effective procedure to decrease the morbidity associated with extensive abdominoperineal resection in the treatment of advanced low rectal and anal malignancies. Rectus abdominis myocutaneous flaps are often utilized in perineal reconstruction with excellent results. However, the main disadvantages are donor-site morbidity and the need for an open procedure after laparoscopic resection, requiring larger incisions with a resultant increase in postoperative pain. Herein, we describe a modified oblique rectus abdominis myocutaneous flap technique that allows sparing of the rectus sheath and the linea alba.
TECHNIQUE
We followed the 3 stages regularly described for the procedure: 1) abdominoperineal resection with simultaneous abdominal and perineal team approach, and removal of the specimen through the perineal wound; 2) right oblique rectus abdominis myocutaneous flap with inferior epigastric pedicle, and release of the rectus muscle from its aponeurotic sheath through the skin paddle incision and transposition of the oblique rectus abdominis myocutaneous flap through an incision in the transversalis fascia; and 3) perineal reconstruction by sutures of the skin paddle to the perineal wound skin edges.
RESULTS
Release of the rectus muscle within its sheath through the incision in the skin paddle turned out to be a simple surgical procedure, without the need of specialized surgical instruments or additional incisions. There were no complications during the postoperative recovery. Our patient was pain-free 1 month after the surgery, with a well-healed flap and abdominal scar.
CONCLUSION
Performance of an oblique rectus abdominis myocutaneous flap that is specifically fitted for the perineal defect after abdominoperineal resection, with muscle dissection performed through the skin paddle incision and transposition into the pelvis through the transversalis fascia, offers good functional outcome while minimizing damage to the abdominal wall.
Identifiants
pubmed: 33216502
doi: 10.1097/DCR.0000000000001710
pii: 00003453-202009000-00021
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1328-1333Références
Musters GD, Sloothaak DA, Roodbeen S, van Geloven AA, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment. Int J Colorectal Dis. 2014;29:1151–1157.
Devulapalli C, Jia Wei AT, DiBiagio JR, et al. Primary versus flap closure of perineal defects following oncologic resection: a systematic review and meta-analysis. Plast Reconstr Surg. 2016;137:1602–1613.
Spasojevic M, Mariathasan AB, Goscinski M, et al. Vertical rectus abdominis musculocutaneous flap repair improves perineal wound healing after abdominoperineal resection for irradiated locally advanced rectal cancer. Ann Surg Oncol. 2018;25:1357–1365.
Shukla HS, Tewari M. An evolution of clinical application of inferior pedicle based rectus abdominis myocutaneous flap for repair of perineal defects after radical surgery for cancer. J Surg Oncol. 2010;102:287–294.
Johnstone MS. Vertical rectus abdominis myocutaneous versus alternative flaps for perineal repair after abdominoperineal excision of the rectum in the era of laparoscopic surgery. Ann Plast Surg. 2017;79:101–106.
Abbott DE, Halverson AL, Wayne JD, Kim JY, Talamonti MS, Dumanian GA. The oblique rectus abdominal myocutaneous flap for complex pelvic wound reconstruction. Dis Colon Rectum. 2008;51:1237–1241.
Lee MJ, Dumanian GA. The oblique rectus abdominis musculocutaneous flap: revisited clinical applications. Plast Reconstr Surg. 2004;114:367–373.
Horch RE, D’Hoore A, Holm T, Kneser U, Hohenberger W, Arkudas A. Laparoscopic abdominoperineal resection with open posterior cylindrical excision and primary transpelvic VRAM flap. Ann Surg Oncol. 2012;19:502–503.