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Does the use of a flap during abdominoperineal resection decrease pelvic wound morbidity?
Vishal Kapoor1, Jana Cole, F Frank Isik
1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, Seattle, Washington 98195-6410, USA.
Abstract:
We hypothesized that the use of muscle flaps, known as tissue transfer (TT), at the time of abdominoperineal resection (APR) reduces perineal wound complications. A restrospective review of patients undergoing an APR at the University of Washington (1984-2003) was conducted. Perineal wound complications and eventual wound healing were compared in patients with and without TT. Ninety-two patients (mean age, 56.6 years) underwent APR; 23.9 per cent (n = 22) had concurrent TT. Patients undergoing TT were more likely to have cancer (91% vs. 77%, P = 0.05) and radiation therapy (86% vs. 52%, P < 0.01). Operative times were nearly 2 hours longer in patients having TT (7.4 hours +/- 2.5 hours vs. 5.6 hours +/- 1.8 hours, P = 0.03), but lengths of stay were similar (13 +/- 5.9 days vs. 12 +/- 7.6 days, P = 0.5). Patients undergoing TT had a higher rate of all wound-healing complications (59% vs. 40%, P = 0.1) and major wound-healing complications (32% vs. 26%, P = 0.6). However, these differences were not statistically significant. No differences in major complications were identified in patients with and without preoperative radiation therapy (26% vs. 28%, P = 0.8). Fifteen per cent (n = 14) of all patients failed to heal wounds at 6 months, but only 9 per cent (n = 2) of patients undergoing TT failed to heal their wounds at 6 months compared with 17 per cent (n = 12) in the non-TT group (P = 0.3). After controlling for important covariates, patients undergoing TT during an APR did not have a significantly lower rate of wound complications. The impact of TT on wound healing in patients with recurrent cancer and preoperative radiation therapy is suggestive of a benefit but requires prospective investigation.
Insights
Tissue transfer (TT) during abdominoperineal resection (APR) did not significantly reduce perineal wound complications in this retrospective study. While trends suggested potential benefits for wound healing in specific patient groups, further prospective research is needed.
Area of Science:
- Surgical Oncology
- Colorectal Surgery
- Wound Healing Research
Background:
- Perineal wound complications are a significant concern following abdominoperineal resection (APR).
- Tissue transfer (TT), a type of reconstructive surgery, is hypothesized to mitigate these complications.
Purpose of the Study:
- To investigate whether concurrent tissue transfer (TT) during abdominoperineal resection (APR) reduces perineal wound complications.
- To compare wound healing outcomes in patients who underwent APR with and without TT.
Main Methods:
- Retrospective review of 92 patients undergoing APR between 1984 and 2003.
- Comparison of perineal wound complication rates and healing times between patients with and without concurrent TT.
- Analysis included patient demographics, cancer characteristics, and treatment history (e.g., radiation therapy).
Main Results:
- Patients undergoing TT had longer operative times but similar lengths of stay compared to non-TT patients.
- No statistically significant differences were observed in overall or major wound healing complication rates between the TT and non-TT groups.
- A trend suggested improved wound healing at 6 months for patients receiving TT, particularly those with prior radiation therapy, though not statistically significant.
Conclusions:
- Concurrent tissue transfer (TT) during abdominoperineal resection (APR) did not significantly lower the rate of perineal wound complications in this study.
- The potential benefit of TT for wound healing in patients with recurrent cancer and preoperative radiation therapy warrants further investigation through prospective studies.
