PMID- 32440406
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220414
IS  - 2169-7574 (Print)
IS  - 2169-7574 (Electronic)
IS  - 2169-7574 (Linking)
VI  - 8
IP  - 4
DP  - 2020 Apr
TI  - Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as 
      a First-line Option?
PG  - e2733
LID - 10.1097/GOX.0000000000002733 [doi]
LID - e2733
AB  - BACKGROUND: Abdominoperineal resection (APR) and pelvic exenteration continue to 
      be common procedures for the treatment of colorectal malignancy. The workhorse 
      flap for reconstruction in these instances has been the vertical rectus abdominis 
      myocutaneous flap. The associated donor site morbidity, however, cannot be 
      ignored. Here, we provide a review of the literature and present the senior 
      author's (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for 
      reconstruction of soft tissue defects following APR and pelvic exenteration. 
      METHODS: Patients who underwent pelvic/perineal reconstruction with pedicled ALT 
      flaps between 2017 and 2019 were included in the study. Parameters of interest 
      included age, gender, body mass index, comorbidities, history of radiation, 
      extent of ablative surgery, and postoperative complication rate. RESULTS: A total 
      of 23 patients (16 men and 7 women) with a median age and body mass index of 66 
      years (inter-quartile range [IQR]: 49-71 years) and 24.9 kg/m(2) (IQR: 
      24.2-26.7 kg/m(2)) were included in the study, respectively. Thirteen (56.5%) 
      patients presented with rectal cancer, 5 (21.7%) with anal squamous cell 
      carcinoma (SCC), 4 (17.4%) with Crohn's disease, and 1 (4.3%) with Paget's 
      disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) 
      patients experienced 11 complications (2 major and 9 minor). The most common 
      complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft 
      tissue coverage was achieved in all but one patient. CONCLUSIONS: The ALT flap 
      allows for stable soft tissue coverage following APR and pelvic exenteration 
      without being associated with abdominal donor site morbidity. Consideration to 
      its use as a first-line reconstructive option should be given in pelvic/perineal 
      reconstruction.
CI  - Copyright (c) 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
      of The American Society of Plastic Surgeons.
FAU - Perrault, David
AU  - Perrault D
AD  - Division of Plastic and Reconstructive Surgery, Stanford University Medical 
      Center, Palo Alto, Calif.
FAU - Kin, Cindy
AU  - Kin C
AD  - Section of Colorectal Surgery, Stanford University Medical Center, Palo Alto, 
      Calif.
FAU - Wan, Derrick C
AU  - Wan DC
AD  - Division of Plastic and Reconstructive Surgery, Stanford University Medical 
      Center, Palo Alto, Calif.
FAU - Kirilcuk, Natalie
AU  - Kirilcuk N
AD  - Section of Colorectal Surgery, Stanford University Medical Center, Palo Alto, 
      Calif.
FAU - Shelton, Andrew
AU  - Shelton A
AD  - Section of Colorectal Surgery, Stanford University Medical Center, Palo Alto, 
      Calif.
FAU - Momeni, Arash
AU  - Momeni A
AD  - Division of Plastic and Reconstructive Surgery, Stanford University Medical 
      Center, Palo Alto, Calif.
LA  - eng
PT  - Journal Article
DEP - 20200424
PL  - United States
TA  - Plast Reconstr Surg Glob Open
JT  - Plastic and reconstructive surgery. Global open
JID - 101622231
PMC - PMC7209827
COIS- Disclosure: Dr. Momeni is a consultant for Allergan, AxoGen, Sientra, and 
      Stryker. The authors have no financial interest to declare in relation to the 
      content of this article.
EDAT- 2020/05/23 06:00
MHDA- 2020/05/23 06:01
PMCR- 2020/04/24
CRDT- 2020/05/23 06:00
PHST- 2020/01/06 00:00 [received]
PHST- 2020/02/04 00:00 [accepted]
PHST- 2020/05/23 06:00 [entrez]
PHST- 2020/05/23 06:00 [pubmed]
PHST- 2020/05/23 06:01 [medline]
PHST- 2020/04/24 00:00 [pmc-release]
AID - 10.1097/GOX.0000000000002733 [doi]
PST - epublish
SO  - Plast Reconstr Surg Glob Open. 2020 Apr 24;8(4):e2733. doi: 
      10.1097/GOX.0000000000002733. eCollection 2020 Apr.