Summary
PURPOSE
Pelvic reconstruction following abdominoperineal resection or pelvic exenteration
is associated with signification surgical site morbidity. Immediate pelvic reconstruction
with a muscle flap is now the gold standard, associated with reduced perineal morbidity
compared to primary closure alone.
2
,
3
The purpose of the present study was to directly compare outcomes of VRAM and gracilis
flap pelvic reconstruction following oncologic resection.METHODS
A multicenter retrospective review was performed of 88 patients who underwent abdominoperineal
resection or pelvic exenteration and immediate pelvic reconstruction, either with
a VRAM (N = 61) or Gracilis flap (N = 27). Electronic medical records were analyzed
for patient demographics, intraoperative data, and postoperative outcomes. Mortality,
minor complication rate, major complication rate and time to complete wound healing
was compared between groups.
RESULTS
Overall, there was no significant difference in the minor complication rate (44% gracilis
vs 48% VRAM, p = 0.8), major complication rate (19% gracilis vs 13% of VRAM, p = 0.53),
30-day mortality (0% VRAM vs 0% gracilis, p = 1.0) and median time to complete wound
healing (68 days vs 67 days, p = 0.19) between the gracilis and VRAM groups. Muscle-only
gracilis flaps had a significantly reduced healing time compared to musculocutaneous
gracilis flaps (48 days vs 85 days, p = 0.007).
CONCLUSIONS
The workhorse flap in pelvic reconstruction remains the VRAM. While previous studies
have alluded to the inferiority of thigh based flaps compared to the VRAM, we demonstrate
here that pelvic reconstruction with the gracilis flap can be performed with comparable
donor and recipient complication rates and similar time to complete wound healing
as the VRAM.
Keywords
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Article info
Publication history
Published online: January 09, 2019
Accepted:
December 21,
2018
Received in revised form:
December 14,
2018
Received:
September 8,
2018
Footnotes
✰Part of this article has been presented at the American Society of Plastic Surgery Annual Meeting (ASPS): Chicago, Illinois- Sept 29th, 2018.
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
