Introduction Abdomino-perineal excision (APE) for anorectal malignancy, particularly following chemo-radiotherapy, is associated with a high rate of perineal wound complications. Biological meshes and tissue flaps such as Vertical Rectus Abdominis Myocutaneous (VRAM) or Inferior Gluteal Artery Perforator (IGAP) flaps can improve wound healing. Should this be carried out in the context of a district general hospital (DGH)? We present a single centre experience using such techniques in a “hub and spoke” model with the regional plastic surgical unit.
Method A retrospective study of 21 patients undergoing APE for malignancy between January 2011 and June 2014 was conducted. IGAP flap reconstruction was performed by a visiting consultant plastic surgeon. Data collection included patient demographics, underlying pathology, neoadjuvant therapy and operative details, length of hospital stay, and wound complications. Patients were followed-up by both colorectal and plastic surgical teams.
Results 21 patients (11 female, mean age 66 ± 12 yrs) underwent APE for cancer (20 rectal adenocarcinoma, 1 anal squamous cell carcinoma). 12 of these patients had received neoadjuvant chemo-radiotherapy.
3 patients had primary closure, 7 biological mesh-assisted, and 12 had tissue flaps (5 VRAM and 7 IGAP). Mean length of hospital stay was 15 ± 8 days. There were no major complications following primary or mesh-assisted closure of the perineum. Perineal wound complications necessitating a return to theatre were seen in 3 patients who had undergone flap closure. Each had received neoadjuvant chemo-radiation.
Conclusion This data suggests that perineal reconstructions following APE for malignancy can be undertaken in a DGH setting using a “hub and spoke” model with a regional plastic surgery unit.
Disclosure of interest None Declared.