• John Pang, Justin M Broyles, Jens Berli, Kate Buretta, Sachin M Shridharani, Danielle H Rochlin, Jonathan E Efron, and Justin M Sacks.
• 1The Department of Plastic Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland 2The Department of General Surgery, Division of Colon and Rectal Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.
• Dis. Colon Rectum. 2014 Jun 1;57(6):725-32.

BackgroundAn abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned.ObjectiveWe report a single surgeon's experience with perineal reconstruction in patients with cancer with the use of either the vertical rectus abdominus myocutaneous flap or the anterolateral thigh flap to demonstrate acceptable outcomes with either repair modality.DesignFrom 2010 to 2012, 19 consecutive patients with perineal defects secondary to cancer underwent flap reconstruction. A retrospective chart review of prospectively entered data was conducted to determine the frequency of short-term and long-term complications.SettingsThis study was conducted at an academic, tertiary-care cancer center.PatientsPatients in the study were patients with cancer who were receiving perineal reconstruction.InterventionsInterventions were surgical and included either abdomen- or thigh-based reconstruction.Main Outcome MeasuresThe main outcome measures included infection, flap failure, length of stay, and time to radiotherapy.ResultsOf the 19 patients included in our study, 10 underwent anterolateral thigh flaps and 9 underwent vertical rectus abdominus myocutaneous flaps for reconstruction. There were no significant differences in demographics between groups (p > 0.05). Surgical outcomes and complications demonstrated no significant differences in the rate of infection, hematoma, bleeding, or necrosis. The mean length of stay after reconstruction was 9.7 ± 3.4 days (± SD) in the anterolateral thigh flap group and 13.4 ± 7.7 days in the vertical rectus abdominus myocutaneous flap group (p > 0.05).LimitationsThe limitations of this study include a relatively small sample size and retrospective evaluation.ConclusionThis study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).

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