Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer

Huang Mitao; Qu Zhan; Liang Pengfei; Liu Weidong; He Zhiyou; Cui Xu; Guo Le; Chen Jie; Li Mengjuan; Huang Xiaoyuan; Zhang Pihong

doi:10.3760/cma.j.cn501225-20231030-00156

Volume 40 Issue 1

Jan. 2024

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(1): 57-63

Huang MT,Qu Z,Liang PF,et al.Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer[J].Chin J Burns Wounds,2024,40(1):57-63.DOI: 10.3760/cma.j.cn501225-20231030-00156.

Citation:

PDF( 5015 KB)

Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer

doi: 10.3760/cma.j.cn501225-20231030-00156

1.
Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
2.
Department of Basic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
3.
Department of Medical Beauty Center, Hunan Provincial Institute of Occupational Disease Control, Changsha 410012, China

Funds:

Youth Fund Program of Hunan Provincial Natural Science Foundation 2022JJ40791

More Information

Corresponding author: Zhang Pihong, Email: zphong@aliyun.com
Received Date: 2023-10-30

Abstract

Abstract

Objective To investigate the clinical effect of the modified vertical rectus abdominis myocutaneous flap in repairing the skin and soft tissue defect after abdominoperineal resection for rectal cancer. Methods This study was a retrospective observational study. From June 2019 to July 2022, five male patients with low rectal cancer who were conformed to the inclusion criteria were admitted to the Department of Basic Surgery of Xiangya Hospital of Central South University, with ages ranging from 65 to 70 years and the sizes of the perianal skin ulcers ranging from 5 cm×4 cm to 11 cm×9 cm, and all of them underwent abdominoperineal resection. The secondary skin and soft tissue defects in the perineum with an area of 8 cm×6 cm-14 cm×12 cm (with the depth of pelvic floor dead space being 10-15 cm) were repaired intraoperatively with transplantation of modified vertical rectus abdominis myocutaneous flaps with the skin area being 9 cm×7 cm-16 cm×12 cm, the volume of the muscle being 18 cm×10 cm×5 cm-20 cm×12 cm×5 cm, and the vessel pedicle being 18-20 cm in length. During the operation, most of the anterior sheath of the rectus abdominis muscle was retained, the flap was transferred to the recipient area through the abdominal cavity, the remaining anterior sheaths of the rectus abdominis muscle on both sides of the donor area were repeatedly folded and sutured, the free edge of the transverse fascia of the abdomen was sutured with the anterior sheath of the rectus abdominis muscle, and the donor area skin was directly sutured. After the operation, the survival of the transplanted myocutaneous flap was observed. The occurrence of complications in the perineal recipient area was recorded within 2 weeks after the operation. The recovery of the perineal recipient area and the abdominal donor area was observed during follow-up, and the occurrence of complications in the donor area of the abdomen as well as the recurrence of tumors and metastasis were recorded. Results All transplanted myocutaneous flaps in 5 patients survived after surgery. One patient had dehiscence of the incision in the perineal recipient area 2 days after surgery, which healed after 7 d with intermittent dressing changes and routine vacuum sealing drainage treatment. In the other 4 patients, no complications such as incisional rupture, incisional infection, or fat liquefaction occurred in the perineal recipient area within 2 weeks after surgery. Follow-up for 6-12 months after discharge showed that the skin of the perineal recipient area had good color, texture, and elasticity, and was not bloated in appearance; linear scars were left in the perineal recipient area and the abdominal donor area without obvious scar hyperplasia or hyperpigmentation; no complications such as incisional rupture, incisional infection, intestinal adhesion, intestinal obstruction, or weakening of the abdominal wall strength occurred in the abdominal donor area, and the abdominal appearance was good with no localized bulge or formation of abdominal hernia; there was no local recurrence of tumor or metastasis in any patient. Conclusions The surgical approach of using the modified vertical rectus abdominis myocutaneous flap to repair the skin and soft tissue defects after abdominoperineal resection for rectal cancer is relatively simple in operation, can achieve good postoperative appearances of the donor and recipient areas with few complications, and is worthy of clinical promotion.
- Wounds and injuries,
- Surgical flaps,
- Rectal neoplasms,
- Vertical rectus abdominis myocutaneous flap,
- Abdominoperineal resection,
- Wound repair

FullText(HTML)

References(22)

References

[1]	中华人民共和国国家卫生健康委员会,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2023年版)[J].中华外科杂志,2023,61(8):617-644.DOI: 10.3760/cma.j.cn112139-20230603-00222.
[2]	BuscailE,CanivetC,ShourickJ,et al.Perineal wound closure following abdominoperineal resection and pelvic exenteration for cancer: a systematic review and meta-analysis[J].Cancers (Basel),2021,13(4):721.DOI: 10.3390/cancers13040721.
[3]	Garcia-HenriquezN,GalanteDJ,MonsonJRT.Selection and outcomes in abdominoperineal resection[J].Front Oncol,2020,10:1339.DOI: 10.3389/fonc.2020.01339.
[4]	WatanaskulS,SchwabME,ColleyA,et al.Robotic repair of perineal hernias: a video vignette and review of the literature[J].Surg Endosc,2023,37(3):2290-2294.DOI: 10.1007/s00464-022-09521-2.
[5]	GultekinS,GartrellR,LuL,et al.Outcomes of perineal reconstruction with inferior gluteal artery myocutaneous flaps and primary closure following abdominoperineal resection[J].ANZ J Surg,2022,92(11):2968-2973.DOI: 10.1111/ans.17769.
[6]	RossiSA,MartineauJJC,GuillierD,et al.Outcomes of the composite anterolateral thigh flap for perineal reconstruction after postoncological abdominoperineal resection[J].Dis Colon Rectum,2022,65(3):373-381.DOI: 10.1097/DCR.0000000000002132.
[7]	SasakiK,YoshimiF,KawasakiH,et al.Usefulness of the gracilis muscle flap for reconstruction of large perineal defects following total pelvic exenteration with sacrectomy[J].ANZ J Surg,2021,91(9):1932-1934.DOI: 10.1111/ans.16566.
[8]	DavilaAA,GoldmanJ,KlebanS,et al.Reducing complications and expanding use of robotic rectus abdominis muscle harvest for pelvic reconstruction[J].Plast Reconstr Surg,2022,150(1):190-195.DOI: 10.1097/PRS.0000000000009233.
[9]	CanessaCE,CalFB,ViglioneNB,et al.Transpelvic oblique rectus abdominis myocutaneous flap with preservation of the rectus sheath[J].Dis Colon Rectum,2020,63(9):1328-1333.DOI: 10.1097/DCR.0000000000001710.
[10]	ZhangYX,HallockGG,SongD,et al.Synchronous closure of a large medial perforator-based superficial circumflex iliac artery perforator free flap donor site using an ipsilateral lateral perforator-based superficial circumflex iliac artery perforator propeller flap[J].Ann Plast Surg,2020,85(2):146-148.DOI: 10.1097/SAP.0000000000002159.
[11]	Copeland-HalperinLR,StewartT,ChenY,et al.Perineal reconstruction following abdominoperineal resection: comprehensive review of the literature[J].J Plast Reconstr Aesthet Surg,2020,73(11):1924-1932.DOI: 10.1016/j.bjps.2020.08.090.
[12]	SpasojevicM,MariathasanAB,GoscinskiM,et al.Vertical rectus abdominis musculocutaneous flap repair improves perineal wound healing after abdominoperineal resection for irradiated locally advanced rectal cancer[J].Ann Surg Oncol,2018,25(5):1357-1365.DOI: 10.1245/s10434-018-6363-3.
[13]	MillerTJ,LavinCV,MomeniA,et al.Prevention and management of complications of tissue flaps[J].Surg Clin North Am,2021,101(5):813-829.DOI: 10.1016/j.suc.2021.06.009.
[14]	MoriGA,TiernanJP.Management of perineal wounds following pelvic surgery[J].Clin Colon Rectal Surg,2022,35(3):212-220.DOI: 10.1055/s-0042-1742414.
[15]	张丕红.浅谈薄型穿支皮瓣切取与穿支血管探测和皮瓣血运评估[J].中华烧伤与创面修复杂志,2023,39(10):911-918.DOI: 10.3760/cma.j.cn501225-20230812-00047.
[16]	KellerDS,BerhoM,PerezRO,et al.The multidisciplinary management of rectal cancer[J].Nat Rev Gastroenterol Hepatol,2020,17(7):414-429.DOI: 10.1038/s41575-020-0275-y.
[17]	黄宇,黄波,刘安铭,等.双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效[J].中华烧伤与创面修复杂志,2023,39(6):540-545.DOI: 10.3760/cma.j.cn501225-20220831-00373.
[18]	Pérez-GarcíaA,García-GraneroÁ,ThioneA,et al.Extended vertical rectus abdominis myocutaneous flap for reconstruction of large pelviperineal defects following oncologic resection[J].J Surg Oncol,2022,126(8):1383-1388.DOI: 10.1002/jso.27068.
[19]	ProctorMJ,WestwoodDA,DonahoeS,et al.Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery[J].Colorectal Dis,2020,22(5):562-568.DOI: 10.1111/codi.14909.
[20]	RadwanRW,TangAM,HarriesRL,et al.Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: a systematic review[J].J Plast Reconstr Aesthet Surg,2021,74(3):523-529.DOI: 10.1016/j.bjps.2020.10.100.
[21]	DewulfM,MuysomsF,VierendeelsT,et al.Prevention of incisional hernias by prophylactic mesh-augmented reinforcement of midline laparotomies for abdominal aortic aneurysm treatment: five-year follow-up of a randomized controlled trial[J].Ann Surg,2022,276(4):e217-e222.DOI: 10.1097/SLA.0000000000005545.
[22]	CollaborativePelvEx.Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative[J].Cancers (Basel),2022,14(5):1161.DOI: 10.3390/cancers14051161.

Relative Articles

[1]	Tong Lin, Zhang Wanfu, Han Fei, Guan Hao. Clinical efficacy of membrane induction technique combined with local myocutaneous flap in repairing sinus cavity pressure injury in the greater trochanteric region[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(5): 443-450. doi: 10.3760/cma.j.cn501225-20231029-00144
[2]	Yang Xuekang, Zhang Dongliang, He Ting, Zhang Yue, Xu Zhigang, Wei Jingtao, Li Jun, Liu Mengdong. Clinical experience of free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting in repairing deep tissue defects of special parts of extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(6): 507-511. doi: 10.3760/cma.j.cn501225-20220915-00407
[3]	Liao Xiaoshuang, Chen Wei, Jiang Haifang, Zhou Jian, Wei Zairong, Chang Shusen, Zhang Fang, Nie Kaiyu. Clinical effects of superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after temporal tumor resection[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(6): 534-539. doi: 10.3760/cma.j.cn501225-20220816-00347
[4]	Qi Jianwu, Chen Shao, Sun Binhong, Chai Yitong, Huang Jian, Li Yi, Yang Keyue, Sun Heyang, Chen Hong. Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(4): 347-353. doi: 10.3760/cma.j.cn501120-20210421-00145
[5]	Wang Hui, Yang Xiaoxi, Huo Yongxin, Hao Ruizheng, Chang Hong, Liu Wei, Wang Bin. Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(8): 758-763. doi: 10.3760/cma.j.cn501120-20200607-00298
[6]	Song Dajiang, Li Zan, Zhou Xiao, Zhang Yixin, Peng Xiaowei, Feng Guang, Zhou Bo, Lyu Chunliu, Wu Peng, Tang Yuanyuan, Peng Wen, Mao Huangxing, Liu Zeyang, Han Weiqing, Chen Yile, Tang Dihong, Zhou Yanjie, Zhang Keqiang. Selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(6): 451-457. doi: 10.3760/cma.j.cn501120-20190320-00129
[7]	Li Pandeng, Shen Guoliang. Clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar defect of ankle[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(5): 392-394. doi: 10.3760/cma.j.issn.1009-2587.2019.05.013
[8]	Gao Qiufang, Zhang Xiaofeng, Zhang Wanfeng, Ma Bin, Niu Xuetao, Ma Yajun, Li Zibiao, Liu Ning. Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(1): 65-68. doi: 10.3760/cma.j.issn.1009-2587.2019.01.012
[9]	Song Dajiang, Li Zan, Zhou Xiao, Zhang Yixin, Peng Xiaowei, Zhou Bo, Lyu Chunliu, Yang Lichang, Peng Wen. Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2017, 33(2): 72-76. doi: 10.3760/cma.j.issn.1009-2587.2017.02.003
[10]	Zhang Wanfeng, Zhang Xiaofeng, Gao Qiufang, Niu Xuetao, Ma Yajun, Wu Baoen, Ma Bin, Liang Feng, Wang Aiwu. Effects of axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata on repairing defects after radical resection of scalp carcinoma in patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2017, 33(8): 491-496. doi: 10.3760/cma.j.issn.1009-2587.2017.08.007
[11]	Chang Shusen, Jin Wenhu, Wei Zairong, Sun Guangfeng, Wang Bo, Deng Chengliang, Tang Xiujun, Zeng Xueqin, Nie Kaiyu. Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(4): 204-207. doi: 10.3760/cma.j.issn.1009-2587.2016.04.004
[15]	SHEN Yu-ming, TIAN Peng, NING Fang-gang, QIN Feng-jun, ZHANG Guo-an. Repair of circumferential wound in the wrist region due to high-voltage electrical burn using com- bined abdominal axial pattern flaps[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2012, 28(6): 408-410. doi: 10.3760/cma.j.issn.1009-2587.2012.06.003
[16]	BEN Dao-feng, MA Bing, CHEN Xu-lin, ZHU Shi-hui, TANG Hong-tai, LU Wei, CHENG Da-sheng, XIAO Shi-chu, XIA Zhao-fan. Repair of deep burn and traumatic wounds in lower extremities with combined transplantation of multiple pedicled skin flaps[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2009, 25(1): 6-9. doi: 10.3760/cma.j.issn.1009-2587.2009.01.004
[18]	WANG Qiang, ZHAO Yu-ling, CAO Quan-bin, HU Fu-xing, ZHU Dian-yong. Repair of massive soft tissue defect in upper and lower extremities with free transmidline bi-lobed scapular skin flap[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2006, 22(6): 437-439.

Supplements(0)

Cited By

Cited by
Periodical cited type(1)
1. 程巩，曹岩，冯亚光. 保肛手术治疗低位直肠癌的临床疗效. 深圳中西医结合杂志. 2024(10): 72-75 .
Other cited types(0)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(2)

Get Citation

PDF

XML

Article Metrics

Article views (193) PDF downloads(27)

Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer

doi: 10.3760/cma.j.cn501225-20231030-00156

Abstract

References

Relative Articles

Cited by

Periodical cited type(1)

Other cited types(0)

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Clinical effect of modified vertical rectus abdominis myocutaneous flap in repairing skin and soft tissue defects after abdominoperineal resection for rectal cancer

doi: 10.3760/cma.j.cn501225-20231030-00156

Abstract

References

Relative Articles

Cited by

Periodical cited type(1)

Other cited types(0)

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Export File

Citation

Format

Content