Biological mesh reconstruction of perineal wounds following extended Abdominoperineal Excision of Rectum (APER): P136

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Aim:Extended APER leaves a large defect in the perineum often filled with a myocutaneous flap. This increases operative time, morbidity and often requires plastic surgery. We report our early experience of repairing the perineal wound with biomesh.Method:Between October 2008 and December 2009 five patients undergoing extended APER had a reconstruction of their pelvic floor using surgiSIS® biological mesh. All cases involved low rectal tumours of stage T2 to T4. In three cases, surgery followed long coursepre-operative radiotherapy.Results:The biological mesh was successfully used in all five cases. Two patients had post-operative wound collections; these were superficial to and did not involve the biomesh. A third patient was experiencing perineal pain one year post-operatively; investigation revealed no mesh infection or other cause. There were no other adverse effects and all patients have subsequently made a good recovery. The median total anaesthetic time was 4 hours 30 mins. Median post-operative hospital stay was 10 days.Conclusion:Biological mesh offers an alternative method for perineal closure following extended APER. Thepresence of a plastic surgeon is not required, operative time is reduced and flap complications are avoided. Further study is required to evaluate this technique against the currently used methods.

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