WE1.1 Bilateral Gracilis Reconstruction following Extra-Levator Abdominoperineal Excision: an updated case-series. (9th August 2022)

• Record Type: Journal Article
• Authors: Jenkins, Evan; Humphrey, Hannah; Watts, Andrew; Rogers, Patrick; Rogers, Patrick; Daniels, Ian
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac248.087
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Circumfrential resection of low rectal or anal cancers poses a challenge to the reconstructive surgeon. Resective procedures including the extralevator abdomino-perineal excision or pelvic exenteration utilise a wide margin of excision, creating a significant tissue deficit. The aim of this case series is to demonstrate that use of bilateral pedicled gracilis muscle flaps (BPGMF) may offer several advantages to other methods of perineal reconstruction. This technique avoids any disruption to the abdominal wall; a benefit in laparoscopic surgery. Fashioning both muscles into a 'weave' creates a muscular sling across the perineum. This offers support to pelvic contents following the excision of the pelvic floor muscle groups. Methods: This is a retrospective, single centre study, of patients undergoing reconstruction of perineal defects using BPGMF. All cases took place between January 2008 to July 2021. Outcomes: There were 56 patients who underwent perineal reconstruction using BPGMF. The indications for surgery were cancer (52 patients) and perineal hernia repair (4 patients). There were 24 female patients and 27 male patients in the patient. The average age of patients was 60 years. The 30 day mortality was 2% (1 patient). A healed perineal wound was seen at 30 days following surgery in 82% (46/56) of patients. The complication rate for the donor site and reconstructed site was 14% and 23% respectively. Complications included infection, hematoma, dehiscence and seroma formation. Conclusion: BPGMF offers a reliable and technically simple muscle flap to reconstruct large perineal defects. It is associated with low morbidity and recreates support to the pelvic floor.