El colgajo V-Y como método de reparación de defectos perianales extensos / V-Y advancement flaps for extensive perianal defect repair

RESUMEN

INTRODUCCIÓN: Algunas enfermedades perianales precisan cirugías agresivas que crean la necesidad de recurrir a técnicas reparadoras para reconstruir la integridad de esta región. El objetivo de este estudio es analizar los resultados a corto y largo plazo tras reconstrucción perianal con colgajos V-Y. MÉTODO: Se ha revisado retrospectivamente nuestra base de datos institucional prospectiva (2000-2013), y se ha incluido en el presente análisis a todos los pacientes a los que se ha realizado una reconstrucción perianal con colgajo V-Y, tras escisión amplia perianal por enfermedad benigna o maligna. Se recogieron datos demográficos, quirúrgicos y la morbilidad a corto y largo plazo. RESULTADOS: Se analizó a un total de 10 pacientes, 6 varones y 4 mujeres, con edad media de 58,1 ± 17,4 años. El tiempo quirúrgico fue 143,5 ± 41,3 min y la estancia hospitalaria media tras la cirugía 7,8 ± 7,7 días. En 8 pacientes aparecieron complicaciones postoperatorias dehiscencia parcial del colgajo (n = 6) y estenosis anal tardía (n = 4). En ningún caso se produjo la pérdida del colgajo. Siete pacientes presentaron buenos resultados en cuanto a la continencia anal, 2 pacientes incontinencia variable y en un caso se realizó una colostomía terminal por incontinencia grave. CONCLUSIÓN: Los colgajos V-Y son una técnica factible y efectiva para cubrir grandes defectos tras cirugías perianales agresivas; sin embargo, no están exentos de morbilidad postoperatoria

ABSTRACT

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. 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. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS: 10 patients were included, 6 males and 4 females. The average age was 58,1 ± 17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5 ± 41,3 min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8 ± 7,6 days. Regarding complications 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n = 4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS: V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity