Novel technique of robotic extralevator abdominoperineal resection with gracilis flap closure

ABSTRACT Repair of post auricular stula are challenging owing to scarred tissue and poor blood supply in this area. Various techniques including locoregional ap cover and cavity obliteration have been utilized to repair this complicated problem. In our report, we introduce a novel technique using a double layer closure utilising local skin ap successful lasting results. Two young adults of age 18 Male and 21 year female. Size of stulas were ranging from 1x2 and 2x2 cm respectively in size. Once the stulous tract was excised two aps were planned for double layer closure of stula. First ap for inner lining was turnover ap. Then another local pivot ap is planned to cover the secondary defect or the raw area. It can be either simple rotation ap as in rst case or Limberg type local transposition nd defect (2 case) ap. Both stulas were healed well. KEYWORDS : Fistula , Post auricular, Flap Closure

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A comparative multicentre study evaluating gluteal turnover flap for wound closure after abdominoperineal resection for rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-021-02496-7 ◽

2021 ◽

Author(s):

S. Sharabiany ◽

J. J. W. van Dam ◽

S. Sparenberg ◽

R. D. Blok ◽

B. Singh ◽

...

Keyword(s):

Rectal Cancer ◽

Wound Healing ◽

Abdominoperineal Resection ◽

Primary Closure ◽

Healing Rate ◽

Perineal Wound ◽

Perineal Hernia ◽

Perineal Wound Healing ◽

Flap Closure ◽

Wound Healing Rate

Abstract Background The aim of this study was to compare perineal wound healing between gluteal turnover flap and primary closure in patients undergoing abdominoperineal resection (APR) for rectal cancer. Methods Patients who underwent APR for primary or recurrent rectal cancer with gluteal turnover flap in two university hospitals (2016–2021) were compared to a multicentre cohort of primary closure (2000–2017). The primary endpoint was uncomplicated perineal wound healing within 30 days. Secondary endpoints were long-term wound healing, related re-interventions, and perineal herniation. The perineal hernia rate was assessed using Kaplan Meier analysis. Results Twenty–five patients had a gluteal turnover flap and 194 had primary closure. The uncomplicated perineal wound-healing rate within 30 days was 68% (17/25) after gluteal turnover flap versus 64% (124/194) after primary closure, OR 2.246; 95% CI 0.734–6.876; p = 0.156 in multivariable analysis. No major wound complications requiring surgical re-intervention occurred after flap closure. Eighteen patients with gluteal turnover flap completed 12-month follow-up, and none of them had chronic perineal sinus, compared to 6% (11/173) after primary closure (p = 0.604). The symptomatic 18-month perineal hernia rate after flap closure was 0%, compared to 9% after primary closure (p = 0.184). Conclusions The uncomplicated perineal wound-healing rate after the gluteal turnover flap and primary closure after APR is similar, and no chronic perineal sinus or perineal hernia occurred after flap closure. Future studies have to confirm potential benefits of the gluteal turnover flap.

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