[Reconstruction of Anorectal Defects Following Oncological Resection].

Abstract

The management of anorectal carcinomas necessitates a multimodal therapeutic approach. Advances in modern medicine have reduced the incidence of complete rectal extirpations and permanent colostomies to below 10%. Despite these improvements, the reconstruction of anorectal defects, particularly following abdominoperineal extirpation (APE) or pelvic exenteration, remains a significant challenge. Deep tissue defects, the impact of neo- or adjuvant radiotherapy, and bacterial contamination contribute to compromised wound healing, with reported complication rates reaching up to 60%.This retrospective study analysed all patients presenting with anorectal defects following oncological surgery in 2024 at a university-based plastic surgery clinic providing maximum-care services. The study assessed various influencing factors, including radiochemotherapy, cachexia, diabetes mellitus, nicotine consumption, vascular diseases, and corticosteroid therapies. Additionally, the evaluation covered the effect of surgical defect coverage using pedicled gracilis flap reconstruction on the number of required interventions and the time to complete wound healing and patient mobilisation.Prolonged intensive care treatment and prior radiochemotherapy were identified as primary contributors to disorders in postoperative wound healing. Moreover, factors such as cachexia, diabetes mellitus, and nicotine consumption had a detrimental impact on wound healing. Plastic-surgical defect reconstruction utilising a pedicled gracilis flap significantly reduced the number of required interventions and expedited recovery time.The interdisciplinary management of patients with anorectal defects post-oncological surgery can be optimised through targeted reconstructive plastic surgery. Pedicled gracilis flap reconstruction has proven to be an effective technique for defect coverage and should be integrated into treatment protocols at an early stage. Further studies are warranted to standardise guidelines, particularly regarding the optimal timing of reconstructive interventions.