7 Reconstruction of Perineum and Abdominal Wall
نویسنده
چکیده
Deep defects at the perineum most frequently result from colorectal or vaginal tumor resection. More superficial but often extensive defects may be caused by radiotherapy, burns or aggressive infections such as necrotizing fasciitis. Resection of colorectal tumors is the main reason for perineal defects that require reconstruction. Abdominoperineal excision of the rectum is largely reserved for larger T2-3 tumors of the distal rectum and poorly differentiated tumors when a safe anastomosis after an anterior resection is not practicable. With the patient in the supine position, the rectum is mobilized down to the pelvic floor via a subumbilical midline incision. After division of the colon, the distal sigmoid is removed as a left iliac fossa colostomy. The distal colon is sutured and folded down into the pelvis. The perineal resection is subsequently performed with the patient in a prone or left lateral position, where utmost care is taken not to allow any tumor spillage by dissecting too close to the rectum. The dissection is therefore performed well into the ischiorectal fossa. The pudendal vessels that supply the anorectal area need to be ligated. For posterior cancers, the coccyx also needs to be resected to provide efficient clearance. In males, damage to the urethra and urethral bulb needs to be avoided. In females, the posterior vaginal wall is resected along with the rectum. These parameters specific to an abdominoperineal rectum amputation determine the difficulty and requirement for reconstruction (Lefevre et al., 2009, Park et al., 2007).
منابع مشابه
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