31. THE PEDICLED VPAP FLAP ALLOWS FOR PRESERVATION OF THE ABDOMINAL WALL IN THE RECONSTRUCTION OF APR DEFECTS

Abstract

PURPOSE: Abdominoperineal resections (APR) often leave large cavitary defects that have historically been reconstructed with vertical rectus abdominus muscle (VRAM) flaps. We present a case series and surgical technique for a novel approach to reconstructing complex defects with a fasciocutaneous flap, the pedicled vertical profunda artery perforator (VPAP) flap, which was first performed for reconstruction of robotic and minimally invasive APR defects in order to preserve the functional abdominal wall. METHODS: A total of 13 patients underwent immediate or delayed reconstruction of APR defects using a pedicled VPAP. Seven patients underwent a minimally invasive APR, with six robotic-assisted and one laparoscopic-assisted procedure, leaving the abdomen completely intact. One patient had a previously failed VRAM, thus the abdomen was unavailable for reconstruction. One patient had bilateral ostomies. Five reconstructions were performed secondarily due to post-operative infection and dehiscence. RESULTS: Of the 13 cases, 2 patients required take back to the operating room for venous congestion. The major complication rate (15.4%) in this series was similar to historically reported rates described for VRAM reconstruction of APR defects. There were no total flap losses or donor site complications. All patients ultimately had successful wound closure. CONCLUSION: The pedicled VPAP presents a viable solution for reconstruction of APR defects while simultaneously preserving the functional abdominal wall in patients who have undergone minimally invasive ablative procedures. Additionally, this technique offers a reconstructive solution in patients that experience post-operative infection and dehiscence, or in whom the abdominal donor site is not available due to bilateral ostomies.