SURGEON AT WORK
Vertical Rectus Muscle Flap Repair for Perineal Defect: Abdominoperineal Resection and Perineal Hernia Shota Takano, MD, Martin Newman, MD, FACS, Kiranjeet Gill, Steven D Wexner, MD, PhD (Hon), FACS, FRCS, FRCS (Ed)
flap was then passed posteriorly and inferiorly and the perineal defect was closed.
This video demonstrates the operative technique of vertical rectus muscle flap repair for perineal defect and highlights key technical tips (Video 1).
Case 2 An 81-year-old male who had several repairs for a perineal hernia after abdominoperineal resection and then underwent vertical rectus abdominus muscle flap repair. The muscle flap without a skin island was harvested with division of the superior aspect of the muscle from the costal margin. The muscle flap was then placed within the pelvic cavity and covered the pelvic opening.
METHODS Intraoperative video recording and compilation of vertical rectus muscle flap repair was performed to highlight the key steps and pitfalls of these procedures. RESULTS The vertical rectus muscle with its unique blood supply coming from the superior and inferior epigastric vessels allows a muscle flap to be created based on a long muscle pedicle with excellent blood supply. The muscle flap is used to reconstruct breast and pelvic or perineal defects.
CONCLUSIONS Vertical rectus muscle repair is an effective method of treating perineal defect.
Case 1 A 53-year-old male with anal cancer had chemoradiation 1 year ago and then local recurrence developed. He underwent abdominoperineal resection with reconstruction of perineal defect with a vertical rectus abdominous myocutaneous pedicle flap. After abdominoperineal resection, a large perineal defect was identified. The rectus muscle with a skin island was harvested with great care to avoid injury to the inferior epigastric vessels. The myocutaneous
Author Contributions Study conception and design: Takano, Newman, Gill, Wexner Acquisition of data: Takano, Newman, Gill, Wexner Analysis and interpretation of data: Takano, Newman, Gill, Wexner Drafting of manuscript: Takano, Newman, Wexner Critical revision: Newman, Wexner
Disclosure Information: Nothing to disclose. Received January 14, 2015; Accepted February 27, 2015. From the Department of Colorectal Surgery (Takano, Wexner) and Department of Plastic Surgery (Newman, Gill), Cleveland Clinic Florida, Weston, FL. Correspondence address: Steven D Wexner, MD, PhD (Hon), FACS, FRCS, FRCS (Ed), Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331. email: [email protected]
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.jamcollsurg.2015.02.034 ISSN 1072-7515/15