B12
GAM 2014 BIARRITZ
ALMOUSAWI H, ASSAF N, ALHARBI M, LIEVAIN L, HERLIN C, SINNA R.
Perforator flaps for perineal reconstruction
Author
Hussein ALMOUSAWI, MD
Plastic Surgery Unit, University Hospital Amiens Nord, Amiens, France *
Email halmousawi@hotmail.com
Co-authors
N. ASSAF, MD *
M. ALHARBI, MD *
L. LIEVAIN, MD *
C. HERLIN, MD *
R. SINNA, MD, PhD *
Abstract
Introduction
Recent report on abdomino-perineal excision seems to show better carcinological margin
when cylindrical excision is performed in a prone position. Furthermore methodological
progress and better anatomical knowledge have reduced the morbidity of reconstructive
surgery. Muscle-sparing flaps and perforator flaps provide the surgeon with additional
options in reconstruction of the perineum.
Material and methods
20 patients have been managed for reconstruction of the perineum after abdominoperineal excision in a prone position. In 16 cases the reconstruction was done in the
same time of the resection. In 4 cases it was done in secondary intention. All patient had
radiotherapy.
Results
There were 8 female (including vaginal reconstruction) and 12 male. All excision margins
were free. In 2 cases the first laparoscopic surgical approach had to be converted to
laparotomy. In all cases, a local single or double propeller flap was possible after
visualization of suitable perforator using the color-Doppler per-operatively. There was no
flap necrosis. Complete healing was obtained in 6 weeks on average.
Conclusion
Improving the carcinological result and diminishing the sequelae after an
abdominoperineal excision seems to be possible with this surgical approach.
Furthermore we propose a decision tree (based on whether abdominal incision is
required or not) based on a multidisciplinary approach.
Keywords
Pudental perforator flap, perineal reconstruction