TY - JOUR
T1 - Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy
T2 - Patient selection, technical caveats, and clinical outcomes
AU - Hultman, Charles S.
AU - Sherrill, Matthew A.
AU - Halvorson, Eric G.
AU - Lee, Clara N.
AU - Boggess, John F.
AU - Meyers, Michael O.
AU - Calvo, Benjamin A.
AU - Kim, Hong J.
PY - 2010/5/1
Y1 - 2010/5/1
N2 - This study assesses the usefulness of the omentum in the reconstruction of complex perineal defects, following abdominoperineal resection or pelvic exenteration, for anorectal malignancy.Between 2000 and 2008, 70 patients (mean age: 59 years) with anorectal malignancy underwent abdominoperineal resection (n = 57) or pelvic exenteration (n = 13) and were reconstructed by primary repair alone (n = 13), primary repair with omentum (n = 16), myocutaneous flap alone (n = 28), or myocutaneous flap with omentum (n = 13). Patients with and without omental flaps were compared by Student t test and χ analysis. Omental flaps were based on a single pedicle, tunneled in the retrocolic plane lateral to the ligament of Treitz, and transposed across the sacrum to the pelvic floor.In total, 29 patients had pelvic floor and perineal reconstruction with the omentum, and 41 patients had reconstruction without the omentum. Incidence of major pelvic complications (abscess, urinoma, deep vein thrombosis, flap dehiscence, hernia, bowel obstruction, fistula) was greater in the "no omentum" group (25/41 patients, 61%), compared with the "omentum" group (6/29 patients, 21%) (P < 0.01). No differences were observed regarding age, stage, incidence of radiotherapy, blood loss, length of stay, or mortality.Use of the omentum as a primary flap, or in combination with a myocutaneous flap, in the reconstruction of complex perineal defects, is associated with a decreased incidence of postoperative complications, strongly supporting the use of the omentum in pelvic floor reconstruction.
AB - This study assesses the usefulness of the omentum in the reconstruction of complex perineal defects, following abdominoperineal resection or pelvic exenteration, for anorectal malignancy.Between 2000 and 2008, 70 patients (mean age: 59 years) with anorectal malignancy underwent abdominoperineal resection (n = 57) or pelvic exenteration (n = 13) and were reconstructed by primary repair alone (n = 13), primary repair with omentum (n = 16), myocutaneous flap alone (n = 28), or myocutaneous flap with omentum (n = 13). Patients with and without omental flaps were compared by Student t test and χ analysis. Omental flaps were based on a single pedicle, tunneled in the retrocolic plane lateral to the ligament of Treitz, and transposed across the sacrum to the pelvic floor.In total, 29 patients had pelvic floor and perineal reconstruction with the omentum, and 41 patients had reconstruction without the omentum. Incidence of major pelvic complications (abscess, urinoma, deep vein thrombosis, flap dehiscence, hernia, bowel obstruction, fistula) was greater in the "no omentum" group (25/41 patients, 61%), compared with the "omentum" group (6/29 patients, 21%) (P < 0.01). No differences were observed regarding age, stage, incidence of radiotherapy, blood loss, length of stay, or mortality.Use of the omentum as a primary flap, or in combination with a myocutaneous flap, in the reconstruction of complex perineal defects, is associated with a decreased incidence of postoperative complications, strongly supporting the use of the omentum in pelvic floor reconstruction.
KW - Abdominoperineal resection
KW - Omental flap
KW - Pelvic exenteration
KW - Pelvic floor reconstruction
UR - http://www.scopus.com/inward/record.url?scp=77951764764&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951764764&partnerID=8YFLogxK
U2 - 10.1097/SAP.0b013e3181ce3947
DO - 10.1097/SAP.0b013e3181ce3947
M3 - Article
C2 - 20395804
AN - SCOPUS:77951764764
SN - 0148-7043
VL - 64
SP - 559
EP - 562
JO - Annals of plastic surgery
JF - Annals of plastic surgery
IS - 5
ER -