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Perineal reconstruction

George Kokosis, Zhifei Sun, Yash J Avashia, Mohamed A Adam, Howard Levinson, Detlev Erdmann, Christopher R Mantyh, John Migaly
BACKGROUND: The aim of this study was to compare wound complications from V-Y flap vs primary closure in the setting of abdominoperineal resection. METHODS: This was a single institution retrospective review (1999-2014). The main outcome measures were any wound complication, hospital length of stay, and unplanned readmissions. RESULTS: Among 80 patients included, 21 (26%) received reconstruction with V-Y flap. Compared with those who received primary closure, patients who underwent V-Y flap reconstruction had lower rates of overall wound complications (14...
July 21, 2016: American Journal of Surgery
Kazuhiko Yoshimatsu, Gakuji Osawa, Hajime Yokomizo, Yuki Yano, Sachiyo Okayama, Akiko Sakuma, Masaya Satake, Yasufumi Yamada, Shinichi Asaka, Takebumi Usui, Kentaro Yamaguchi, Shunichi Shiozawa, Takeshi Shimakawa, Takao Katsube, Yoshihiko Naritaka
A 78-year-old man visited our hospital with a prolapsed hemorrhoid. He was referred to the dermatology unit due to the thickness and redness of the perianal skin. He was diagnosed as having extra mammary Paget's disease by skin biopsy. After a biopsy of the anal polyp was performed to investigate the primary site, he was diagnosed with early anal canal cancer with Pagetoid spread and underwent a radical operation. Abdominoperineal resection with skin(D2 prx D3 lymphadenectomy) was performed with perineal reconstruction using a gracilis muscle graft...
October 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Wei Ge, Song-Song Jiang, Wang Qi, Hao Chen, Li-Ming Zheng, Gang Chen
GOAL: To share our experience of extra-levator abdominoperineal excision (ELAPE) for low rectal cancer, focusing on perineal repair with biological mesh. METHODS: We retrospectively analyzed medical records of all patients with low rectal cancer who underwent the ELAPE procedure using biological mesh for perineal repair at the Gastrointestinal Surgery of Nanjing Drum Power Hospital between January 2013 and September 2015. All patients were closely followed up to now...
October 6, 2016: Oncotarget
Sarah J Moore, Omid Rashidipour, Ronald B Moore
This male patient presented with a scrotal abscess and urinary obstruction. The patient's history included a perineal abscess and the development of urethrocutaneous fistulae (watering-can perineum). He underwent multiple debridement procedures without resolution. During the fifth debridement for Fournier's gangrene, a biopsy revealed invasive squamous cell carcinoma. The patient was bedridden because of the large mass, a wide en bloc resection with lymphadenectomy and reconstruction was performed revealing a large (22 cm) squamous cell carcinoma originating from the urethra...
2016: Clinical Medicine Insights. Case Reports
Natashia M Seemann, Sebastian K King, Abdul Elkadri, Thomas Walters, Joel Fish, Jacob C Langer
BACKGROUND/PURPOSE: Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. METHODS: A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed...
September 15, 2016: Journal of Pediatric Surgery
Seung Woo Cho, Hak Chang, Sung Tack Kwon
Extramammary Paget's disease (EMPD) is a rare, slow-growing intraepithelial malignancy that mainly involves the genital region, including the vulva, penis, scrotum, perianal, and periurethral areas. Although several treatment options exist, wide local excision with a safe margin is considered the treatment of choice. After resection of the lesion, it is often challenging to reconstruct the defect because defects in the perineal region require adequate volume for protection and are susceptible to infections, which is a particularly significant risk for large defects...
September 2016: Archives of Plastic Surgery
Ki Wook Sung, Won Jai Lee, In Sik Yun, Dong Won Lee
BACKGROUND: Perineal defects are commonly encountered during the treatment of conditions such as malignancy, infectious disease, and trauma. Covering large defects in the perineal area is challenging due to its complicated anatomy and the need for functional preservation. METHODS: Fourteen patients who underwent reconstructive surgery with multiple perforator flaps for defects >100 cm(2) in the perineal area were included in this retrospective cohort study. Characteristics of the perforator flap operation and postoperative outcomes were reviewed...
September 2016: Archives of Plastic Surgery
Marisa M Clifton, Raffi Gurunluoglu, Javier Pizarro-Berdichevsky, Todd Baker, Sandip P Vasavada
INTRODUCTION: Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap. METHODS: We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation...
September 28, 2016: International Urogynecology Journal
Wouter B Van der Sluis, Mark-Bram Bouman, Marlon E Buncamper, Margriet G Mullender, Wilhelmus J Meijerink
BACKGROUND: Vaginal (re)construction can greatly improve the quality of life of indicated patients. If primary vaginoplasty fails, multiple surgical approaches exist for revision. The authors compared surgical results of laparoscopic intestinal versus full-thickness skin graft revision vaginoplasty. METHODS: A retrospective chart review of patients who underwent revision vaginoplasty at the authors' institution was conducted. Patient demographics, surgical characteristics, complications, hospitalization, reoperations, and neovaginal depth for both surgical techniques were recorded and compared...
October 2016: Plastic and Reconstructive Surgery
Charlotte R Gould, Graham Branagan
AIM: Phantom rectum is the sensation of an intact and/or functioning rectum, despite excision at surgery. Abdominoperineal excision of the rectum (APER) may be complemented by reconstructive operations and recently it was reported that patients undergoing APER and vertical rectus abdominis myocutaneous (VRAM) flap reconstruction are more prone to develop phantom sensations at an earlier timeframe and have more persistent symptoms than those who do not have perineal repairs. The aim of this study was to determine the prevalence of phantom rectal sensations in a cohort of these patients...
November 2016: International Journal of Colorectal Disease
Aly Youssef, Marta Cavalera, Giuseppina Pacella, Ginevra Salsi, Giovanni Morganelli, Elisa Montaguti, Ilaria Cataneo, Gianluigi Pilu, Nicola Rizzo
OBJECTIVES: Caudal distension of female pelvic floor is common and results in perineal descent and a caudally curved hiatus (so called 'warping'). All the available ultrasound techniques to date however aim to reconstruct the pelvic floor using linear techniques (flat plane reconstruction). We aimed to evaluate the feasibility, reproducibility and potential usefulness of a new 3D technique, capable of reconstructing a curved plane of the levator hiatus. METHODS: We recruited a group of primiparous women to perform a 3D/4D transperineal ultrasound 3-6 months after delivery...
September 19, 2016: Ultrasound in Obstetrics & Gynecology
A L A Bloemendaal, R Kraus, N C Buchs, F C Hamdy, R Hompes, L Cogswell, R J Guy
AIM: In advanced pelvic cancer it may be necessary to perform a total pelvic exenteration. In such cases urinary tract reconstruction is usually achieved with the creation of an ileal conduit with a urinary stoma on the right side of the patient's abdomen and an end colostomy separately on the left. The potential morbidity from a second stoma, may be avoided by the use of a double-barrelled wet colostomy (DBWC), as a single stoma. Another advantage is the possibility to use a vertical rectus abdominis muscle (VRAM) flap for perineal reconstruction...
September 13, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Vincenzo Puppo
The World Health Organization reports that more than 200 million women currently alive have been subjected to female genital mutilation/cutting (FGM/C) worldwide, and three million girls continue to be at risk each year. FGM/C today is women's business. The vulva is formed by the labia majora and the vestibule, with its erectile apparatus. These structures are located under the urogenital diaphragm, behind the pubic symphysis in the anterior perineal region. The clitoris is entirely an external genital organ: the glans and body covered by the prepuce are visible/free while the roots are hidden...
September 6, 2016: Clinical Anatomy
Yu Yoshino, Kimihiko Funahashi, Rei Okada, Yasuyuki Miura, Takayuki Suzuki, Takamaru Koda, Kimihiko Yoshida, Junichi Koike, Hiroyuki Shiokawa, Mitsunori Ushigome, Tomoaki Kaneko, Yasuo Nagashima, Mayu Goto, Akiharu Kurihara, Hironori Kaneko
BACKGROUND: Fournier's gangrene in the setting of rectal cancer is rare. Treatment for Fournier's gangrene associated with rectal cancer is more complex than other cases of Fournier's gangrene. We report on a patient with severe Fournier's gangrene in the setting of locally advanced rectal cancer who was treated with a combined modality therapy. CASE PRESENTATION: A 65-year-old man presented with general fatigue and anal pain. The medical and surgical histories were unremarkable...
2016: World Journal of Surgical Oncology
Noelia Ibañez, Jesús Abrisqueta, Juan Luján, Quiteria Hernández, Pascual Parrilla
OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS: A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps...
August 20, 2016: Cirugía Española
Michelle Sieffert, James Ouellette, Michael Johnson, Todd Hicks, Minia Hellan
BACKGROUND: The purpose of this paper is to introduce a robotic assisted approach to extralevator abdominoperineal excision in the modified Lloyd-Davis position with reconstruction of the perineum using pedicled gracilis flaps, and to discuss outcomes in a cohort of six patients. METHODS: Data was collected by chart review on six patients who underwent extralevator excision with gracilis flap reconstruction from 10/2013 to 06/2015. Technical details, operative data, oncologic outcomes, and wound healing complications were evaluated...
July 20, 2016: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
Ricardo Horta, Ricardo Nascimento, Alvaro Silva, Jose Amarante
Perineal wounds present a special challenge for reconstructive surgeons. The vacuum-assisted closure device is useful as a temporizing measure or for wounds too large or contaminated for immediate reconstruction. Compared to traditional myocutaneous flaps, perforator flaps provide thinner fasciocutaneous flaps for perineal reconstruction with favorable results and fewer donor site morbidities. The upper and lower gluteal regions are rich in perforators, which allow for more versatile flap design according to the defect...
June 2016: Wounds: a Compendium of Clinical Research and Practice
Natalia Mukai, Lílian Vital Pinheiro, Maria de Lourdes Setsuko Ayrizono, Guilherme Cardinali Barreiro, Paulo Kharmandayan, Mariana Hanayo Akinaga, Adriano Mesquita Bento, Carlos Augusto Real Martinez, Rita Barbosa de Carvalho, Marc Ward, Cláudio Saddy Rodrigues Coy, Raquel Franco Leal
INTRODUCTION: Chronic suppurative hidradenitis (CSH) is a benign condition that can affect the perineal region and often leads to the formation of abscesses and fistulas. It is rare for CSH to undergo malignant degeneration into mucinous adenocarcinoma. PRESENTATION OF CASE: We report a case of a 55-year-old male patient with perineal CSH who suffered worsening long-term pain despite multiple surgical procedures to alleviate his symptoms. Pelvic magnetic resonance imaging (MRI) showed multiloculated cystic lesion on the left side wall of the distal rectum with gluteal extension...
2016: International Journal of Surgery Case Reports
Mansher Singh, Sarah Kinsley, Anne Huang, Joseph A Ricci, Thomas E Clancy, Jennifer Irani, Joel Goldberg, Elizabeth Breen, Ronald Bleday, Simon G Talbot
BACKGROUND: Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here we evaluate the role for thigh-based flaps founded on acceptable outcomes and low morbidity. STUDY DESIGN: Consecutive patients referred to a single surgeon between January 2012 and August 2015 who underwent perineal reconstruction with a pedicled gracilis flap were identified...
October 2016: Journal of the American College of Surgeons
H Sumrien, P Newman, C Burt, K McCarthy, A Dixon, A Pullyblank, A Lyons
BACKGROUND: Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and hysterectomy. The aim of the present study was to determine whether negative pressure therapy applied to closed perineal wounds after ELAPE improved wound healing and compare outcomes to the published literature and outcomes from a historical cohort of patients who had undergone 'standard' abdominoperineal resection (APR) and primary closure of the perineal wounds...
September 2016: Techniques in Coloproctology
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