Perineal reconstruction with local flaps: technique and results

Area of Science:

• Surgical reconstruction
• Perineal defect management
• Anal canal reconstruction

Background:

• Wide excision of perineal lesions, including the anal canal, presents significant closure challenges, particularly when preserving continence.
• Reconstruction of large perineal defects is complex, necessitating effective surgical techniques.

Purpose of the Study:

• To evaluate the efficacy of local flap reconstruction for large perineal defects following wide excisions.
• To assess functional outcomes, including continence, after local flap repair.

Main Methods:

• A retrospective review of 20 patients undergoing wide perineal/anal canal excisions and local flap reconstruction (1994-2009).
• Indications included squamous cell carcinoma, Buschke-Lowenstein tumors, and other conditions. Procedures involved wide local excision or abdominoperineal resection (APR).
• Reconstruction utilized bilateral local flaps (V-Y or S), with 13 patients preserving the anal canal.

Main Results:

• No perioperative deaths; mean hospital stay was 4.2 days. Wound dehiscence occurred in 30% of patients, with radiation identified as a significant risk factor.
• Long-term follow-up showed 12 of 14 eligible patients with an intact anal canal achieved full continence, and 2 had partial continence.
• Outcomes were generally favorable, even in immunocompromised patients, though local flaps were problematic in irradiated cases.

Conclusions:

• Local flap reconstruction is a viable and effective method for managing large perineal and anal canal defects.
• Continence can often be preserved following this reconstructive approach.
• Caution is advised, and local flaps should be avoided in patients with prior radiation therapy to the perineum.