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Outcomes of the Composite Anterolateral Thigh Flap for Perineal Reconstruction After Postoncological Abdominoperineal Resection.

BACKGROUND
The vertical rectus abdominis flap is considered the gold standard in perineal reconstruction after oncological abdominoperineal resection, however has a non-negligible donor site morbidity. The anterolateral thigh flap offers reliable soft tissue coverage.


OBJECTIVE
The aim was to analyze long term outcomes of composite anterolateral thigh-vastus lateralis flaps in oncological abdominoperineal resections.


DESIGN
We conducted a retrospective cohort analysis of a prospectively maintained database.


SETTINGS
This study was conducted in the Lausanne university hospital. Annually, approximately 10 oncological abdomioperineal resections are performed. Literature reports 7-20% of patients undergoing abdominoperineal resection requiring flap reconstruction; in our institution, approximately 2 patients with large defects after abdominoperineal resections required reconstruction.


PATIENTS
Twenty-nine pedicled anterolateral thigh-vastus lateralis flaps in 27 consecutive patients (mean age 63 years +/-11.2, 23 with radio-chemotherapy) after abdominoperineal resection to cover large defects (median 190 cm2, 48-600 cm2) were analyzed.


INTERVENTION
Pedicled composite anterolateral thigh-vastus lateralis flaps were performed after oncological abdominoperineal resection.


MAIN OUTCOME MEASURES
Descriptive statistical analysis was conducted. Short and long-term outcomes were analyzed, uni- and multivariate analysis were performed. Median follow-up was 16 months (12-48 months).


RESULTS
Flap-related postoperative complications occurred in 16 flaps, flap-survival was 100%. Multivariate logistic analysis identified initial defect size as predictive for complications. Patients with larger defects (≥ 190 cm2) had higher complication rates (**p=0.006). Long-term analysis revealed three chronic fistulae, two tumor recurrences, one flap dysesthesia and one perineal acne inversa.


LIMITATIONS
Limitations include retrospective analysis, selection bias and lacking a control group. Sample size limits statistical power.


CONCLUSIONS
The pedicled anterolateral thigh-vastus lateralis flap offers reliable, stable tissue with low morbidity and good long-term outcomes. Complications compared favorably with current literature describing perineal reconstructions with rectus abdominis flaps. The composite anterolateral thigh flap is a valid alternative without the setback of abdominal donor site morbidity. See Video Abstract at http://links.lww.com/DCR/B757.