Oblique Rectus Abdominis Myocutaneous Versus Anterolateral Thigh-Vastus Lateralis Flap for Perineal Reconstruction: A Retrospective Comparative Study

BACKGROUND: Abdominoperineal resection (APR) may result in significant postoperative defects, with high rates of wound healing complications, especially after radiotherapy. No consensus exists regarding the optimal flap for perineal reconstruction after APR. METHODS: This 2-center retrospective study included patients undergoing perineal reconstruction with an oblique rectus abdominis myocutaneous (ORAM) flap or an anterolateral thigh-vastus lateralis (ALT-VL) flap between September 2015 and March 2020. Outcomes of interest were perioperative complications, wound healing time, and length of stay. RESULTS: Twenty-four patients were included (ORAM, n = 10; ALT-VL, n = 14). The mean length of stay and time to complete healing were 26.7 ± 14.31 and 39.3 ± 38.8 days in the ORAM group, compared with 33.14 ± 17.02 and 20.64 ± 8.76 days in the ALT-VL group, respectively (P = 0.340 and P = 0.167). The groups were also similar for overall (40% versus 28.6%; P = 0.439), major (10% versus 7.1%; P = 0.670), and minor (30% versus 21.4%; P = 0.494) perineal complication rates. Concerning donor-site complications, 3 (30%) patients in the ORAM group developed postoperative bulging, whereas 1 patient in the ALT-VL group experienced postoperative seroma (P = 0.178). CONCLUSIONS: Both ORAM and ALT-VL flaps provided effective and reliable reconstruction of perineal defects after APR, with comparable complication rates. The ALT-VL flap was associated with lower donor-site morbidity, making it a favorable option. ORAM, given the possibility of transabdominal transfer, remains particularly useful when concomitant vaginal wall reconstruction is required.

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