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Seung Ha Park - One of the best experts on this subject based on the ideXlab platform.
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Comparison of the Complications in Vertical Rectus Abdominis Musculocutaneous Flap with Non-Reconstructed Cases after Pelvic Exenteration
Archives of plastic surgery, 2014Co-Authors: Heechang Jeon, Eul Sik Yoon, Hijin You, Hyon Surk Kim, Byung Il Lee, Seung Ha ParkAbstract:Background Perineal Reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage. Methods We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such Reconstruction. Results Flap Reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n = 9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n = 9), peritonitis and bowel obstruction occurred in 1 case (11%). Conclusions Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate Perineal Reconstruction to prevent major complications of pelvic exenteration.
Rami W Radwan - One of the best experts on this subject based on the ideXlab platform.
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Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies.
World journal of surgery, 2021Co-Authors: Rhiannon L. Harries, Rami W Radwan, Madlen Dewi, Jonathan Cubitt, James Warbrick-smith, Omair Sadiq, John Beynon, Martyn D. Evans, Peter DrewAbstract:Increasingly radical surgery combined with neo-adjuvant radiotherapy present a challenge for the reconstructive surgeon. The study objective was to review outcomes of Vertical Rectus Abdominis Myocutaneous (VRAM) flap-based Perineal Reconstruction following resectional surgery for pelvic malignancies. Single-centre retrospective analysis of patients undergoing immediate VRAM flap Reconstruction of a Perineal/pelvic defect for pelvic malignancy between July 2009 and November 2017. Primary outcome was Perineal morbidity (surgical site infection (SSI), flap loss or dehiscence and Perineal hernia). Secondary outcomes were length of stay and donor site morbidity (SSI, full-thickness dehiscence and incisional hernia). A total of 178 patients (96 females) were included. Median age was 67 years (range 28-88). The majority were performed for locally advanced rectal adenocarcinoma (n = 122; 68.5%) and 136 (76.4%) patients had received neoadjuvant radiotherapy. Four patients had complete flap loss (2.3%), and 40 had Perineal dehiscence (22.5%); however, only, 18 patients required a return to theatre during the admission for Perineal-related complications (10.1%). Abdominal dehiscence occurred in six patients (3.4%). Median length of post-operative stay was 15 days (6-131). Sixty-day mortality rate was 1.1%. SSI at the midline and perineum occurred in 34 (19.1%) and 38 patients (21.3%), respectively. At 90-day post-operatively, 75.6% of Perineal wounds were healed. During a median follow-up of 44.5 months, twelve, eleven and 39 patients were diagnosed with Perineal, midline and parastomal hernias, respectively (6.9%, 6.2% and 21.9%). It is important to have accurate knowledge of Perineal and donor-site morbidity rates to allow an informed consent process.
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Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies
World Journal of Surgery, 2021Co-Authors: Rhiannon L. Harries, Rami W Radwan, Madlen Dewi, Jonathan Cubitt, James Warbrick-smith, Omair Sadiq, John Beynon, Martyn D. Evans, Peter DrewAbstract:Background Increasingly radical surgery combined with neo-adjuvant radiotherapy present a challenge for the reconstructive surgeon. The study objective was to review outcomes of Vertical Rectus Abdominis Myocutaneous (VRAM) flap-based Perineal Reconstruction following resectional surgery for pelvic malignancies. Methods Single-centre retrospective analysis of patients undergoing immediate VRAM flap Reconstruction of a Perineal/pelvic defect for pelvic malignancy between July 2009 and November 2017. Primary outcome was Perineal morbidity (surgical site infection (SSI), flap loss or dehiscence and Perineal hernia). Secondary outcomes were length of stay and donor site morbidity (SSI, full-thickness dehiscence and incisional hernia). Results A total of 178 patients (96 females) were included. Median age was 67 years (range 28–88). The majority were performed for locally advanced rectal adenocarcinoma ( n = 122; 68.5%) and 136 (76.4%) patients had received neoadjuvant radiotherapy. Four patients had complete flap loss (2.3%), and 40 had Perineal dehiscence (22.5%); however, only, 18 patients required a return to theatre during the admission for Perineal-related complications (10.1%). Abdominal dehiscence occurred in six patients (3.4%). Median length of post-operative stay was 15 days (6–131). Sixty-day mortality rate was 1.1%. SSI at the midline and perineum occurred in 34 (19.1%) and 38 patients (21.3%), respectively. At 90-day post-operatively, 75.6% of Perineal wounds were healed. During a median follow-up of 44.5 months, twelve, eleven and 39 patients were diagnosed with Perineal, midline and parastomal hernias, respectively (6.9%, 6.2% and 21.9%). Conclusions It is important to have accurate knowledge of Perineal and donor-site morbidity rates to allow an informed consent process.
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Vertical rectus abdominis flap (VRAM) for Perineal Reconstruction following pelvic surgery: A systematic review.
Journal of plastic reconstructive & aesthetic surgery : JPRAS, 2020Co-Authors: Rami W Radwan, Alethea M Tang, Rhiannon Harries, Eleanor G Davies, P.j. Drew, M. EvansAbstract:Summary Background The vertical rectus abdominis myocutaneous (VRAM) flap is an established technique employed to reconstruct pelvic and Perineal defects not amenable to primary closure. The aim of this study was to systematically review the morbidity of VRAM flap Reconstruction following exenterative pelvic surgery. Materials and methods A systematic literature search was conducted by using Medline, EMBASE, and Cochrane databases. Abstracts of all studies published from inception to November 2019 were identified. Search terms used included ‘vertical rectus abdominis myocutaneous’, ‘vertical rectus abdominis musculocutaneous’ and ‘VRAM’. Only studies that described outcomes when a VRAM flap was used during exenterative pelvic surgery were included; case reports were excluded. The primary outcome measure was VRAM flap morbidity. Secondary outcome measures included donor site morbidity and hospital length of stay. Results Sixty-five studies with a total of 1827 patients were identified and included. Perineal Reconstruction was most commonly performed following abdominal Perineal excision of the rectum (APER) (n = 636 and 34.8%). Median patient age at surgery ranged from 38 to 78 years. Mean Perineal flap morbidity was 27%, with a complete flap loss rate of 1.8% and a Perineal hernia rate of 0.2%. Mean donor site morbidity was 15%, with an abdominal dehiscence rate of 5.5% and an incisional hernia rate of 3.3%. Conclusions While overall morbidity after VRAM flap Reconstruction in pelvic visceral surgery is high; the risk of major complications remains low. These data are important when counselling patients for surgery.
Peter Drew - One of the best experts on this subject based on the ideXlab platform.
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Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies
World Journal of Surgery, 2021Co-Authors: Rhiannon L. Harries, Rami W Radwan, Madlen Dewi, Jonathan Cubitt, James Warbrick-smith, Omair Sadiq, John Beynon, Martyn D. Evans, Peter DrewAbstract:Background Increasingly radical surgery combined with neo-adjuvant radiotherapy present a challenge for the reconstructive surgeon. The study objective was to review outcomes of Vertical Rectus Abdominis Myocutaneous (VRAM) flap-based Perineal Reconstruction following resectional surgery for pelvic malignancies. Methods Single-centre retrospective analysis of patients undergoing immediate VRAM flap Reconstruction of a Perineal/pelvic defect for pelvic malignancy between July 2009 and November 2017. Primary outcome was Perineal morbidity (surgical site infection (SSI), flap loss or dehiscence and Perineal hernia). Secondary outcomes were length of stay and donor site morbidity (SSI, full-thickness dehiscence and incisional hernia). Results A total of 178 patients (96 females) were included. Median age was 67 years (range 28–88). The majority were performed for locally advanced rectal adenocarcinoma ( n = 122; 68.5%) and 136 (76.4%) patients had received neoadjuvant radiotherapy. Four patients had complete flap loss (2.3%), and 40 had Perineal dehiscence (22.5%); however, only, 18 patients required a return to theatre during the admission for Perineal-related complications (10.1%). Abdominal dehiscence occurred in six patients (3.4%). Median length of post-operative stay was 15 days (6–131). Sixty-day mortality rate was 1.1%. SSI at the midline and perineum occurred in 34 (19.1%) and 38 patients (21.3%), respectively. At 90-day post-operatively, 75.6% of Perineal wounds were healed. During a median follow-up of 44.5 months, twelve, eleven and 39 patients were diagnosed with Perineal, midline and parastomal hernias, respectively (6.9%, 6.2% and 21.9%). Conclusions It is important to have accurate knowledge of Perineal and donor-site morbidity rates to allow an informed consent process.
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Outcomes Following Immediate Vertical Rectus Abdominis Myocutaneous (VRAM) Flap-Based Perineal Reconstruction Following Resectional Surgery For Pelvic Malignancies.
World journal of surgery, 2021Co-Authors: Rhiannon L. Harries, Rami W Radwan, Madlen Dewi, Jonathan Cubitt, James Warbrick-smith, Omair Sadiq, John Beynon, Martyn D. Evans, Peter DrewAbstract:Increasingly radical surgery combined with neo-adjuvant radiotherapy present a challenge for the reconstructive surgeon. The study objective was to review outcomes of Vertical Rectus Abdominis Myocutaneous (VRAM) flap-based Perineal Reconstruction following resectional surgery for pelvic malignancies. Single-centre retrospective analysis of patients undergoing immediate VRAM flap Reconstruction of a Perineal/pelvic defect for pelvic malignancy between July 2009 and November 2017. Primary outcome was Perineal morbidity (surgical site infection (SSI), flap loss or dehiscence and Perineal hernia). Secondary outcomes were length of stay and donor site morbidity (SSI, full-thickness dehiscence and incisional hernia). A total of 178 patients (96 females) were included. Median age was 67 years (range 28-88). The majority were performed for locally advanced rectal adenocarcinoma (n = 122; 68.5%) and 136 (76.4%) patients had received neoadjuvant radiotherapy. Four patients had complete flap loss (2.3%), and 40 had Perineal dehiscence (22.5%); however, only, 18 patients required a return to theatre during the admission for Perineal-related complications (10.1%). Abdominal dehiscence occurred in six patients (3.4%). Median length of post-operative stay was 15 days (6-131). Sixty-day mortality rate was 1.1%. SSI at the midline and perineum occurred in 34 (19.1%) and 38 patients (21.3%), respectively. At 90-day post-operatively, 75.6% of Perineal wounds were healed. During a median follow-up of 44.5 months, twelve, eleven and 39 patients were diagnosed with Perineal, midline and parastomal hernias, respectively (6.9%, 6.2% and 21.9%). It is important to have accurate knowledge of Perineal and donor-site morbidity rates to allow an informed consent process.
S. Laurberg - One of the best experts on this subject based on the ideXlab platform.
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Perineal Healing and Survival After Anal Cancer Salvage Surgery: 10-Year Experience with Primary Perineal Reconstruction Using the Vertical Rectus Abdominis Myocutaneous (VRAM) Flap
Annals of Surgical Oncology, 2009Co-Authors: K. G. Sunesen, S. Buntzen, T. Tei, J. C. Lindegaard, M. Nørgaard, S. LaurbergAbstract:Salvage surgery of recurrent or persistent anal cancer following radiotherapy is often followed by Perineal wound complications. We examined survival and Perineal wound complications in anal cancer salvage surgery during a 10-year period with primary Perineal Reconstruction predominantly performed using vertical rectus abdominis myocutaneous (VRAM) flap. Between 1997 and 2006, 49 patients underwent anal cancer salvage surgery. Of these, 48 had primary Reconstruction with VRAM. Overall survival was computed by the Kaplan–Meier method and mortality rate ratios (MRRs) by Cox regression. One patient (2%) died within 30 days postoperatively. Postoperative complications necessitated reoperation in eight (16%) patients. We found no major Perineal wound infections. Major Perineal wound breakdown occurred in the only patient in whom VRAM was not used. Five-year survival was 61% [95% confidence interval (CI) 43–75%]. Free resection margins (R0) were obtained in 78% of patients, with 5-year survival of 75% (95% CI 53–87%). Involved margins, microscopically only (R1) or macroscopically (R2), strongly predicted an adverse outcome [age-adjusted 2-year MRRs (95% CI) R1 vs. R0 = 4.1 (0.7–23.6), R2 vs. R0 = 10.9 (2.2–54.2)]. We conclude that anal cancer salvage surgery can yield long-time survival but obtaining free margins is critical. A low rate of Perineal complications is achievable by primary Perineal Reconstruction using VRAM flap.
Arash Momeni - One of the best experts on this subject based on the ideXlab platform.
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Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option?
Plastic and reconstructive surgery. Global open, 2020Co-Authors: David P. Perrault, Cindy Kin, Derrick C. Wan, Natalie Kirilcuk, Andrew A. Shelton, Arash MomeniAbstract:Background AbdominoPerineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for Reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author's (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for Reconstruction of soft tissue defects following APR and pelvic exenteration. Methods Patients who underwent pelvic/Perineal Reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate. Results A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49-71 years) and 24.9 kg/m2 (IQR: 24.2-26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn's disease, and 1 (4.3%) with Paget's disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial Perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient. Conclusions The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/Perineal Reconstruction.
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pelvic Perineal Reconstruction time to consider the anterolateral thigh flap as a first line option
Plastic and reconstructive surgery. Global open, 2020Co-Authors: David Perrault, Cindy Kin, Derrick C. Wan, Natalie Kirilcuk, Andrew A. Shelton, Arash MomeniAbstract:Background AbdominoPerineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for Reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author's (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for Reconstruction of soft tissue defects following APR and pelvic exenteration. Methods Patients who underwent pelvic/Perineal Reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate. Results A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49-71 years) and 24.9 kg/m2 (IQR: 24.2-26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn's disease, and 1 (4.3%) with Paget's disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial Perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient. Conclusions The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/Perineal Reconstruction.
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Sarcopenia Is a Risk Factor for Infection for Patients Undergoing AbdominoPerineal Resection and Flap-based Reconstruction.
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Travis J. Miller, Clifford C. Sheckter, Leandra A. Barnes, Arash MomeniAbstract:AbdominoPerineal resection (APR) carries a high risk of morbidity. Preoperative risk assessment can help with patient counseling, minimize adverse outcomes, and guide surgeons in their choice of Reconstruction. This study examined the impact of sarcopenia (low lean muscle mass) on postoperative complications after APR. Methods One hundred seventy-eight patients who underwent APR between May 2000 and July 2017 were retrospectively analyzed. Sarcopenia was identified on preoperative computed tomography scans using the Hounsfield Unit Average Calculation. Two cohorts were compared (group 1: primary Perineal closure; group 2: flap-based Perineal Reconstruction). Multivariable analysis evaluated predictors of complications. Results Sarcopenia was an independent risk factor for postoperative surgical site infection in patients undergoing APR (odds ratio [OR] = 2.9, P = 0.04). The risk for sarcopenic patients who underwent flap-based Perineal Reconstruction was even higher (OR = 8.9, P < 0.01). Male sex was also found to be a risk factor for infection (OR = 3.5, P < 0.01). Perineal flap-based Reconstruction was a risk factor for delayed wound healing (OR = 3.2, P < 0.01). Conclusions Sarcopenia was an independent risk factor for infection in patients undergoing APR. This risk was even greater in patients undergoing flap-based Perineal Reconstruction. Sarcopenia can be identified on preoperative imaging and inform surgeons on risk stratification and surgical plan.