外科杂志

Updates in Pelviperineal Reconstruction Options After Abdominoperineal Resection

Abstract

Dan Cristian Moraru, Viorel Scripcariu

Abdominoperineal resection may be the only curative solution for invasive or recurrent malignant tumors in the pelvic-perineal region. Recent studies have established that immediate pelvic-perineal reconstruction following abdominoperineal resection is associated with superior primary healing, decreased postoperative complications, rapid recovery and reinsertion with increased quality of life for the patient. Currently, many reconstructive options for the perineal defect after abdominoperineal resection are available, ranging from primary direct closure to flap reconstruction. Better knowledge of the progress attained in the care of the perineal defect after abdominoperineal and rectal resection can help the surgeon make a better choice for each patient. There is no consensus on the optimal technique after abdominoperineal resection. In this article, various closure techniques are presented, from direct closure, closure fastened with meshes to the autologous reconstruction by musculocutaneous flaps, which until recently have been the "gold standard" for perineal reconstruction. The main donor sites for musculocutaneous flaps include the rectus abdominis, gracilis or gluteus maximus muscles. The reconstruction option should be carefully chosen to establish a significant balance between the reconstructive needs and the morbidity of the donor site. A review of these techniques and their development is provided to offer a general overview of what has been done, what can be done currently and what may be done in the future.