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Meta-Analysis
. 2016 May;137(5):1602-1613.
doi: 10.1097/PRS.0000000000002107.

Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis

Chris Devulapalli  1   2 , Anne Tong Jia Wei  1   2 , Jennifer R DiBiagio  1   2 , Marcelo L Baez  1   2 , Pablo A Baltodano  1   2 , Stella M Seal  1   2 , Justin M Sacks  1   2 , Carisa M Cooney  1   2 , Gedge D Rosson  1   2
Affiliations
Meta-Analysis

Primary versus Flap Closure of Perineal Defects following Oncologic Resection: A Systematic Review and Meta-Analysis

Chris Devulapalli et al. Plast Reconstr Surg. 2016 May.

Abstract

Background: Abdominoperineal resection and pelvic exenteration for resection of malignancies can lead to large perineal defects with significant surgical-site morbidity. Myocutaneous flaps have been proposed in place of primary closure to improve wound healing. A systematic review was conducted to compare primary closure with myocutaneous flap reconstruction of perineal defects following abdominoperineal resection or pelvic exenteration with regard to surgical-site complications.

Methods: A comprehensive literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. After data extraction from included studies, meta-analysis was performed to compare outcome parameters defining surgical-site complications of flap and primary closure.

Results: Our systematic review yielded 10 eligible studies (one randomized controlled trial and nine retrospective studies) involving 566 patients (226 flaps and 340 primary closures). Eight studies described rectus abdominis myocutaneous flaps and two studies used gracilis flaps. In meta-analysis, primary closure was more than twice as likely to be associated with total perineal wound complications compared with flap closure (OR, 2.17; 95 percent CI, 1.34 to 3.14; p = 0.001). Rates of major perineal wound complications were also significantly higher in the primary closure group (OR, 3.64; 95 percent CI, 1.43 to 7.79; p = 0.005). There was no statistically significant difference between primary and flap closure for minor perineal wound complications, abdominal hernias, length of stay, or reoperation rate.

Conclusions: This is the first systematic review with meta-analysis comparing primary closure with myocutaneous flap closure for pelvic reconstruction. The authors' results have validated the use of myocutaneous flaps for reducing perineal morbidity following abdominoperineal resection or pelvic exenteration.

Clinical question/level of evidence: Therapeutic, II.

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References

    1. Barker JA, Blackmore AE, Owen RP, Rate A. Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon. Int J Colorectal Dis. 2013;28:801806.
    1. Tei TM, Stolzenburg T, Buntzen S, Laurberg S, Kjeldsen H. Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery. Br J Surg. 2003;90:575580.
    1. Fowler JM. Incorporating pelvic/vaginal reconstruction into radical pelvic surgery. Gynecol Oncol. 2009;115:154163.
    1. Chessin DB, Hartley J, Cohen AM, et al. Rectus flap reconstruction decreases perineal wound complications after pelvic chemoradiation and surgery: A cohort study. Ann Surg Oncol. 2005;12:104110.
    1. Mathes SJ, Feng LJ, Hunt TK. Coverage of the infected wound. Ann Surg. 1983;198:420429.

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