Author(s): Barrie J.; Haque A.; Evans D.A.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 34
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available at Colorectal Disease - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: Extralevator abdominoperineal resection (ELAP) may be complicated by perineal wound problems. We report a consecutive series with selective use of a fasciocutaneous V-Y buttock advancement flap (BAF). Methods: Data were collected on consecutive patients undergoing ELAP for rectal cancer between August 2011 and March 2016. Demographics, management and outcomes were recorded prospectively. Perineal wound problems were considered 'major' if they required packing, otherwise being classed as 'minor'. Results: 28 patients (4 female, 24 male) underwent an ELAP. Median age was 65 (35-89). 27 had an adenocarcinoma, 1 had a malignant melanoma. 12 patients had a BAF. 19 received long-course pre-operative chemoradiotherapy. One patient received pre-operative contact radiotherapy (Papillon) and one contact radiotherapy with external beam radiotherapy. One patient had previously received radical radiotherapy for prostate cancer. Median tumour height (from the anal verge) was 30 mm (0-80). Median length of stay was 12 days (5-26). Median follow-up was 26 months (2-66). Minor wound breakdown occurred in 13. Two of the 12 patients having BAF had a major wound breakdown. One wound took 9 months to completely heal, the other is not yet healed (recent surgery). Of the 16 patients who did not have a BAF, one had a major wound breakdown which closed by 3 months. There were no perineal fistulae or chronic sinuses. There was one perineal hernia, repaired by perineal insertion of biologic mesh (Permacol)TM(Covidien, Dublin). Conclusion: Selective use of BAF in perineal closure can give good results in terms of healing and perineal hernia formation.
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