Sj. Loessin et al., MANAGEMENT OF SACRAL AND PERINEAL DEFECTS FOLLOWING ABDOMINOPERINEAL RESECTION AND RADIATION WITH TRANSPELVIC MUSCLE FLAPS, Diseases of the colon & rectum, 38(9), 1995, pp. 940-945
PURPOSES: In this study we present our experience with treating persis
tent sacral and perineal defects secondary to radiation and abdominope
rineal resection with or without sacrectomy. METHODS: Fifteen consecut
ive patients were treated with an inferiorly based transpelvic rectus
abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15
patients achieved healing, and 7 patients had no complications. The r
emaining eight patients required one or more operative debridements an
d/or prolonged wound care to accomplish a healed wound. Our technique
for the dissection and insetting of the transpelvic muscle flap is pre
sented. CONCLUSION: The difficult postirradiated perineal and sacral w
ounds can be healed with persistent surgical attention to adequate deb
ridement, control of infections, and a well-vascularized muscle flap.
The most satisfying aspects for patients are the discontinuance of fou
l-smelling discharge, discontinuation of multiple, daily dressing chan
ges, and reduction in the degree of chronic pain.