Central perforated VRAM flap and neurostimulated levator augmentation for functional and aesthetical reconstruction after abdominoperineal excision in cancer

Article type: Research Article

Authors: Bernuth, Silvia^a | Jakubietz, Michael^a | Isbert, Christoph^b | Reibetanz, Joachim^c | Meffert, Rainer^a | Jakubietz, Rafael^a | Schmidt, Karsten^{a; *}

Affiliations: [a] Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany | [b] Department of General, Visceral and Coloproctological Surgery, Amalie Sieveking Hospital Hamburg, Hamburg, Germany | [c] Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany

Correspondence: [*] Corresponding author: Karsten Schmidt, Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Oberdürrbacher Straße 6, 97080 Würzburg, Germany. Tel.: +49 931 201 37001; E-mail: [email protected].

Abstract: BACKGROUND: Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery. OBJECTIVE: Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty. METHODS: 14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained. RESULTS: Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients. CONCLUSION: The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Keywords: VRAM, perineostoma, dynamic graciloplasty, perineal reconstruction

DOI: 10.3233/THC-213021

Journal: Technology and Health Care, vol. 30, no. 4, pp. 815-825, 2022