複雑な会陰部欠損に対する下殿動脈筋皮弁を用いた周術期リスク因子と長期予後

Radical pelvic extirpative surgery is associated with high perioperative morbidity. The inferior gluteal artery myocutaneous (IGAM) flap was introduced and subsequently refined to optimize patient results in this setting. This study evaluated perioperative factors, flap-specific complications, donor-site morbidity and long-term outcomes in patients undergoing IGAM reconstructions following pelvic exenteration or abdominoperineal resection.

Data were prospectively collected and reviewed for adult patients treated at the Peter MacCallum Cancer Centre, Melbourne, Australia between January 2013 and 2025. Statistical analyses assessed the relationships between patient demographics, clinical features, reconstructive characteristics, and outcomes. The primary outcome was partial or total flap failure. Secondary outcomes included unplanned return to theatre, wound dehiscence, surgical site infection, and perioperative transfusion.

Among 107 patients, the median age was 63 years and there was a male predominance (57.9%). Within this cohort 53.3% had recurrent disease and 98.1% were irradiated prior to reconstruction. The median overall survival was 68.6 months and the 5-year overall survival was 54.9%. Univariate analysis demonstrated significantly increased rates of perioperative complications in males, smokers, sarcopenic patients and those with recurrent disease. Multivariate logistic regression confirmed these associations. Sarcopenic patients were 4.9 times more likely to experience perioperative complications (p = 0.010).

IGAM flaps provided acceptable flap-specific complication rates, low donor-site morbidity and consistently favourable treatment outcomes for complex perineal reconstruction. Male sex, smoking, sarcopenia and recurrent disease were significantly associated with worse perioperative outcomes. These findings support the continued use of the IGAM for patients undergoing radical pelvic and perineal surgery.