"Impact of Limberg Flap Reconstruction Following Abdominoperineal Resection: A Randomized Controlled Trial."

Perineal wound complications after abdominoperineal resection (APR) for low rectal cancer remain a significant challenge. Effective reconstruction methods are critical to reducing morbidity and improving outcomes.

To compare the effectiveness of primary closure versus Limberg flap reconstruction in managing perineal defects post-abdominoperineal resection.

Sixty patients undergoing APR for rectal cancer were randomized into two groups. Fifty-four patients completed the study and were analyzed (26 in the primary closure group and 28 in the Limberg flap group). Baseline characteristics, including mean age, gender distribution, cancer stage, and neoadjuvant chemoradiation status, were recorded. Primary outcomes included uncomplicated wound healing, while secondary outcomes assessed complications, wound healing time, and hospital stay. Statistical significance was set at p < 0.05.

The average age of the participants was 68.04 ± 11.50 years, with an average weight of 74.42 ± 12.47 kg and a mean Body Mass Index (BMI) of 27.31 ± 3.90 kg/m². Males comprised 57.4% of the sample, 38.9% of whom had diabetes, and nearly 80% underwent neoadjuvant chemoradiation therapy. The Limberg flap group exhibited significantly lower complication rates (17.9% compared to 42.3%, p = 0.02), reduced wound healing times (6.14 ± 2.07 days compared to 8.12 ± 4.01 days, p = 0.03), and shorter hospitalization durations (7.68 ± 2.96 days compared to 11.35 ± 6.27 days, p = 0.008). Among diabetic patients in the primary closure cohort, there are significant differences in the rates of complications, infections, and wound dehiscence (p < 0.02, p < 0.02, p < 0.01, respectively).

Limberg flap reconstruction offers superior outcomes compared to primary closure for perineal reconstruction following APR.