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J Reconstr Microsurg 2022; 38(02): 089-095
DOI: 10.1055/s-0041-1729750
Original Article

Pelvic Reconstruction following Abdominoperineal Resection and Pelvic Exenteration: Management Practices among Plastic and Colorectal Surgeons

Michael J. Stein
1   Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Canada
,
Aneesh Karir
2   Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Canada
,
Melissa N. Hanson
3   Division of General Surgery, McGill University, Montreal, Canada
,
Naveen Cavale
4   Division of Plastic and Reconstructive Surgery, Kings College, London, United Kingdom
,
Alex M. Almoudaris
5   Division of General Surgery, University College Hospital, London, United Kingdom
,
Sophocles Voineskos
6   Division of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations Funding This study was performed without external funding. None of the authors have commercial associations or financial disclosures that might pose a conflict of interest with information presented in this manuscript.
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Abstract

Background Pelvic reconstruction with a muscle flap significantly improves postoperative outcomes following abdominoperineal resection (APR). Despite it being the gold standard, significant surgeon-selection bias remains with respect to the necessity of pelvic obliteration, flap choice, and ostomy placement. The objective of the study was to characterize management practices among colorectal surgeons (CSs) and plastic surgeons (PSs).

Methods Specialty-specific surveys were distributed electronically to CSs and PSs via surgical societies. Surveys were designed to illustrate geographic and specialty-specific differences in management.

Results Of 106 (54 CSs and 52 PSs) respondents (58% Canada, 21% Europe, 14% the United States, and 6% Asia/Africa), significant interdisciplinary differences in practices were observed. Most respondents indicated that multidisciplinary meetings were not performed (74% of CSs and 78% of PSs). For a nonradiated pelvic dead space with small perineal defect, 91% of CSs and 56% of PSs indicated that flap reconstruction was not required. For a radiated pelvic dead space with small perineal defect, only 54% of CSs and 6% of PSs indicated that there was no need for flap reconstruction. With respect to ostomy placement, 87% of CSs and 21% of PSs indicated that stoma placement through the rectus was superior. When two ostomies were required, most CSs preferred exteriorizing ostomies through bilateral recti and requesting thigh-based reconstruction. PSs favored the vertical rectus abdominis muscle (VRAM; 52%) over the gracilis (23%) and inferior gluteal artery perforator (IGAP; 23%) flaps. Among PSs, North Americans favor abdominally based flaps (VRAM 60%), while Europeans favor gluteal-based flaps (IGAP 78%).

Conclusion A lack of standardization continues to exist with respect to the reconstruction of pelvic defects following APR and pelvic exenteration. Geographic and interdisciplinary biases with respect to ostomy placement, flap choice, and role for pelvic obliteration continues to influence reconstructive practices. These cases should continue to be approached on a case by case basis, driven by pathology, presence of radiation, comorbidities, and the size of the pelvic and perineal defect.

Keywords

pelvic reconstruction - pelvic exenteration - abdominoperineal resection

Supplementary Material



Publication History

Received: 02 November 2020

Accepted: 14 March 2021

Article published online:
29 June 2021

© 2021. Thieme. All rights reserved.

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