RECONSTRUCTION OPTIONS FOR CHALLENGING PERINEAL DEFECTS

Year 2024, Volume: 87 Issue: 4, 275 - 282, 25.10.2024

Dicle Aksöyler , Mehmet Can Nergizoğullari , Yiğit Yalçın , Erol Kozanoğlu , Bora Edim Akalın , Leman Damla Ercan , Cemil Burak Kulle , Özlem Polat , Müşerref Beril Dinçer , Yağmur Minareci , Cemalettin Ertekin , Rıfat Atilla Arıncı

https://doi.org/10.26650/IUITFD.1467973

Abstract

Objective: Abdominoperineal resection and pelvic exenteration for the surgical treatment of advanced colorectal or gynaecological cancers can result in large perineal defects and severe surgical site morbidity. Several regional flaps can be used to treat radiation- and extirpative surgery-related wound breakdowns. This study aims to retrospectively evaluate the efficiency of different flaps used in the reconstruction of perineal defects.
Material and Method: A retrospective review of pelvic reconstructions performed between May 2021 and August 2023 was conducted, with a 6-month follow-up. Ten patients who underwent abdominoperineal resection with immediate abdominal-based flap (n=4) or thigh-based flap (n=6) reconstruction of the perineal/pelvic defect were evaluated. The two groups were compared in terms of patient characteristics, aetiology, preferred treatment, and postoperative complications.
Result: Five women and five men underwent comprehensive pelvic reconstruction. The mean age was 49.6 years (range 26–76) and mean BMI of 28.6 kg/m2 (range 21.3–50). Five patients had previously undergone radiotherapy. In total, 11 flaps were created based on the type of perineal defect. One patient experienced a minor dehiscence (<5 cm). Two patients experienced major dehiscence (>5 cm), and required reoperation. A patient with Crohn’s disease developed one intra-abdominal abscess because of spontaneous fistula formation. There was no vascular compromise in the flaps.
Conclusion: Repair options vary depending on the nature of the defect and extent of resection. The primary goals of reconstruction are to eliminate pelvic dead space and separate the intra-abdominal content from the perineum to prevent herniation and strangulation of the small intestines and to ensure that the perineal wound heals without complications.

Keywords

Abdominoperineal resection, flap, pelvic exenteration, perineal reconstruction, radiotherapy

Ethical Statement

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Supporting Institution

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Thanks

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ZORLAYICI PERİNE DEFEKTLERİNDE ONARIM SEÇENEKLERİ

Abstract

Amaç: İleri evre kolorektal veya jinekolojik kanserlerin cerrahi tedavisinde abdominoperineal rezeksiyon ve pelvik ekzenterasyon ameliyatları büyük perineal defektlere ve ciddi cerrahi alan morbiditesine neden olabilir. Radyasyon ve onkolojik cerrahiye bağlı yara iyileşme problemlerini engellemek için çeşitli bölgesel flepler yara kapatılmasında kullanılabilir.
Gereç ve Yöntem: Mayıs 2021 ile Ağustos 2023 arasında gerçekleştirilen pelvik rekonstrüksiyon vakaları geriye dönük olarak altı aylık takip süresi ile incelendi. Toplamda 10 hasta çalışmaya dahil edildi. Bu hastalara karın temelli flepler (n=4) ve uyluk temelli flepler (n=6) kullanılarak perineal defekt rekonstrüksiyonu gerçekleştirildi. Bu iki hasta grubu hastaların demografik özellikleri, etiyoloji, tercih edilen tedavi yöntemi ve ameliyat sonrası gelişen komplikasyonlar açısından karşılaştırıldı.
Bulgular: Beş kadın ve beş erkeğe kapsamlı pelvik rekonstrüksiyon uygulandı; yaş ortalaması 49,6 (26-76 aralığı) ve ortalama vücut kitle indeksi (VKI) 28,6 kg/m2 (21,3-50 aralığı) idi. Beş hastaya daha önce radyoterapi uygulanmıştı. Perine defektinin tipine göre toplam 11 flep uygulandı. Bir hastada yara yerinde küçük bir ayrılma (<5 cm) oldu. İki hastada yara yerinde büyük açılma oldu (>5 cm) ve yeniden ameliyat edilmeleri gerekti. Crohn hastalığı olan hastada spontan fistül oluşumu sonucu karın içi abse gelişti. Fleplerde kısmi veya tam kayıp izlenmedi.
Sonuç: Onarım seçenekleri defektin boyutuna ve rezeksiyonun derecesine bağlı olarak değişmektedir. Rekonstrüksiyonda öncelikli amaç pelvik ölü boşluğu ortadan kaldırmak ile karın içi içeriğin perineden ayrılmasını sağlamak, ince bağırsakların fıtıklaşmasını önlemek ve komplikasyonsuz yara iyileşmesini sağlamaktır.

Keywords

Abdominoperineal rezeksiyon, flep, pelvik ekzenterasyon, perineal rekonstrüksiyon, radyoterapi

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