Medical Journal of The Islamic Republic of Iran (MJIRI)

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Radiation-related wounds challenge surgeons in all disciplines of surgery. Wound-healing complications are commonplace, and solutions for reconstruction are limited. Muscle and musculocutaneous flaps have improved this situation. But the question is, does previous radiation of the muscle to be transposed affect the outcome? 143 consecutive previously irradiated patients treated with muscle or musculocutaneous flaps composed the group under consideration: these 143 patients had 206 muscles transposed. The overall complication rate for muscle transposition to close a radiated wound was 20 percent. Of the 143 patients who received radiation, 62 patients had the muscle transposed for wound closure from the primary field of radiation. 81 patients were closed with non-irradiated muscle. When the transposed muscle had been radiated, the complication rate was 29.6 percent in 14.3 percent, the entire muscle underwent necrosis, requiring total removal and a second tissue transposition from a non-irradiated source to achieve closure. The subgroup using non-irradiated muscle had a complication rate of 12.2 percent 1 patient in this group had complete flap necrosis requiring a second tissue transposition. No postoperative deaths were encountered. The experience in our department reveals that non-irradiated muscle is the best choice for closure of a radiated wound, if possible.

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Smoking has been shown to be a complicating factor in normal wound healing. Both nicotine and carbon monoxide adversely affect multiple stages of the healing process. From 1991 to 1999,407 muscle flap procedures were performed on 374 patients in a single surgical unit. A retrospective review of 261 patients was completed. Patients were divided into three groups: Group A, no smoking history group B, smokers for at least one year, and group C, active smokers up to the time of surgery. Patients were excluded who had diabetes, had a recurrent malignancy, or used steroids. A total of 261 patients were included in the study. The age, sex, number of patients and primary operative indications were matched in the 3 groups. Active smokers were shown to have a complication rate significantly higher in the immediate post-operative period compared with non-smokers and smokers who had quit. The most common complications were partial muscle necrosis and partial skin graft loss. This series suggests that active smoking at the time of muscle transposition significantly increases the rate of postoperative complications.

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Background: Abdominoperineal resection (APR) is the standard surgical treatment for low-lying anorectal malignancies. It seems that immediate flap reconstruction has fewer complications compared to primary closure. There are several options for local flap reconstruction of perineal wound closure, and each specific flap method has its own advantages and disadvantages.
   Case presentation: In this case report, a new method of reconstruction is presented which contains only the inferior part of the rectus abdominis muscle in 2 patients, one with unilateral and the other with bilateral involvement and they both underwent APR. Both patients were referred to the colorectal surgery clinic for APR by an oncologist. Both patients had severe constipation and both reported pain on defecation and rectorrhagia. Patient 1 received a unilateral inferior part of rectus abdominis muscle flap and patient 2 received a bilateral flap.
   Conclusion: Immediate flap reconstruction after APR has fewer complications than primary closure and the inferior part of rectus abdominis muscle flap seems to be a possible means of reconstruction after APR.