Modified V-Y Flap Reconstruction Following Abdominoperineal Resection in Irradiated Patients: Analysis of 10 Years of Experience

Background: – Wound complications following primary closure after abdominoperineal resection reach rates of up to 66%. The de-epithelialized V-Y flap has emerged as a common closure technique, particularly in irradiated patients. This study evaluates the 10-year experience of the modified V-Y flap at our institution. Methods: – A retrospective review of patients who underwent de-epithelialized V-Y flap reconstruction for abdominoperineal resection defects between 2013 and 2024 was performed. An analysis of wound complications (eg, infections, dehiscence) and surgical outcomes (eg, reoperations, readmissions) was performed. Multivariate logistic regression assessed the effects of comorbidities and operative factors on wound complications, 30-day reoperations, 30-day readmissions, interventional radiology drainage, and length of stay. Results: – Eighty-three patients were included, with a wound complication rate of 30.1%. The most common complication was pelvic fluid collections (22.9%), followed by dehiscence (21.7%). Within 30 days, 6 (7.2%) patients required reoperation, and 13 (15.7%) patients were readmitted. Patients with chronic obstructive pulmonary disease (P = 0.046) or atrial fibrillation (P = 0.048) were more likely to have wound complications. Mesh use (n = 6) was associated with higher wound complications (P = 0.02), reoperations (P = 0.03), readmissions (P < 0.001), and interventional radiology drainage (P = 0.01). Conclusions: – The modified V-Y flap demonstrated improved wound complication with more robust data compared with our prior study. Patients with chronic obstructive pulmonary disease or atrial fibrillation may face higher risks of wound complications. Mesh use was associated with an increased rate of complications and interventions.

Duke Scholars

Author Detlev Erdmann Surgery, Plastic, Maxillofacial, and Oral Surgery

Author Brett Thomas Phillips Surgery, Plastic, Maxillofacial, and Oral Surgery

Author Hani Naga  

Author Ash Patel Surgery, Plastic, Maxillofacial, and Oral Surgery