Perineal Reconstruction Techniques in Oncologic Surgery
Summary
Perineal defects arising from oncologic resections of the lower rectum, anus and pelvic organs present a unique reconstructive challenge due to the depth of the cavity, proximity to contaminated fields and frequent use of neoadjuvant radiotherapy. Techniques range from simple primary closure to complex flap and mesh reconstructions. Primary perineal closure remains common for small defects but carries a high risk of wound dehiscence and delayed healing. Myocutaneous flaps such as the vertical rectus abdominis myocutaneous (VRAM) flap, pedicled gracilis and gluteal V-Y flaps provide well-vascularised tissue to fill dead space and resist infection. Perforator flaps, notably the inferior gluteal artery perforator (IGAP) flap, spare donor muscle and reduce morbidity. Biological meshes and omental transfers have been introduced to reinforce the pelvic floor and limit perineal hernia formation. Recent interest has focused on minimally invasive harvest, donor-site preservation and tailored, patient-specific approaches delivered by multidisciplinary teams to optimise functional outcome and quality of life.
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Perineal Reconstruction Techniques in Oncologic Surgery publication trend
The graph below shows the total number of articles in perineal reconstruction techniques in oncologic surgery across all publications each year (not limited to Nature Index journals).
Technical terms
Extralevator abdominoperineal excision (ELAPE): A wide radical resection of the rectum and anal sphincters extending laterally to the levator muscles to minimise local recurrence.
Myocutaneous flap: A composite tissue transfer including muscle and overlying skin, used to fill pelvic defects with well-vascularised tissue.
Perforator flap: A flap harvested on isolated skin and subcutaneous vessels (perforators) without sacrificing underlying muscle, reducing donor morbidity.
Vertical rectus abdominis myocutaneous (VRAM) flap: A pedicled flap using the rectus abdominis muscle and skin paddle, commonly employed for pelvic floor reconstruction.
Biological mesh: An implant derived from decellularised tissue matrix that reinforces soft tissue defects and integrates with host tissue.
Omentoplasty: The mobilisation of omental fat into a pelvic cavity to obliterate dead space and promote vascularised coverage.
References
- Feasibility of Perineal Defect Reconstruction with Simplified Fasciocutaneous Inferior Gluteal Artery Perforator (IGAP) Flaps after Tumor Resection of the Lower Rectum: Incidence and Outcome in an Interdisciplinary Approach. Cancers (2023).
- Use of Rectus Flaps in Reconstructive Surgery for Gynecologic Cancer. Current Oncology (2024).
- Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis. Cancers (2021).
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