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Early rehabilitation after perineal reconstruction with musculocutaneous flaps
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
fact, none of the participants (initially) recalled missing any appointment or deliberately not attending a session. Of these themes, two were very strong. The uncertainty regarding what physiotherapy was ‘Placing value on the unknown’ meant participants were apprehensive about turning up for appointments or had trouble prioritizing physiotherapy over other commitments. Conversely, ‘Convenience’ such as easy cheap bus routes, free parking and easy access to the physiotherapy rooms strongly encouraged attendance. Conclusion(s): Participants believed that physiotherapy was beneficial. However, uncertainty regarding the aims of physiotherapy affected participants’ ability to value its worth and consequently affected attendance. Convenience of location facilitates attendance in people living in poor socioeconomic geographical areas. Implications: A strong professional identity in conjunction with strategic marketing might improve health literacy and facilitate physiotherapy outpatient attendance. Keywords: Health inequalities; Access; Musculoskeletal physiotherapy outpatients Funding acknowledgements: This research received a University of Otago Research Grant (UORG). Ethics approval: Ethical approval was obtained from The University of Otago Ethics Committee (12/311) and from Hutt Valley District health Board (HVDHB). http://dx.doi.org/10.1016/j.physio.2015.03.2122 Research Report Poster Presentation Number: RR-PO-19-07-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 EARLY REHABILITATION AFTER PERINEAL RECONSTRUCTION WITH MUSCULOCUTANEOUS FLAPS A. Persson Skåne University Hospital, Department of Surgery, Malmö, Sweden Background: Advanced colorectal cancer can lead to abdominoperineal resection (APR) which results in large loss of perineal tissue. The pelvic floor can be reconstructed by replacing the removed tissue with a musculocutaneous flap, which also facilitates the healing process. Several reconstructive options have been described included vertical rectus abdominis musculocutaneous (VRAM) and gluteus maximus musculocutaneous flap (GM). For VRAM reconstruction, the flap is transected leaving a few cm attached to the pubic bone. Thereafter the flap is rotated and tunneled through the pelvis. This makes possible a reconstruction of the posterior vaginal wall, if needed. The abdominal wall is reinforced by a mesh to compensate the loss of stability. This procedure takes long time and involves several turnings of the patient.
eS1197
Reconstruction with a GM-flap means that 1/3 of the muscle is transected, usually based cranially and then rotated medially to fill the space. This is a less flexible method that is not likely to fill the tissue defect as well as VRAM flap. Furthermore, it could be that the extension strength of the hip is weakened due to the fact that a large part of the muscle is removed. It is, however, a less complicated operation, surgery duration is shorter and there is no damage on the abdominal wall. Few studies investigate how muscular function and strength are affected by reconstructions. To our knowledge, none of them compare these two different operative techniques regarding early rehabilitation of patients. Purpose: The aim of the study was to compare two different operative techniques by measuring early rehabilitation and wound healing. Moreover, to facilitate relevant preoperative information to patients. Methods: A retrospective study was carried out by a follow-up of hospital records of 50 patients who underwent APR with flap reconstruction between June 2010 and April 2014. 29 patients were reconstructed with GM and 21 with VRAM technique. Data was monitored regarding the first time out of bed after surgery, when achieved a certain walking distance and wound healing. All patients had the same access to guided rehabilitation. Results: Day 1: 13 patients with GM respective 5 patients with VRAM flap had been out of bed. Walk minimum 10 meters at day 2: 7 patients with GM respective 0 with VRAM flap. Walk minimum 10 meters at day 7: 23 patients with GM respective 17 with VRAM flap. Walk minimum 100 meters at day 7: 18 patients with GM respective 12 with VRAM flap. Median hospitalization was 17, 5 days for GM and respective 28 days for VRAM flap. Completely healed flap at time of discharge was 31% for GM respective 33% for VRAM technique. Conclusion(s): Our study shows that patients with GM flap reconstruction were faster in early rehabilitation and the hospitalization was shorter. No significance was found in the total amount of completely healed flap wounds. A followup regarding functional tests over a longer period would be desirable. Implications: These results are important for technical improvement and relevant preoperative patient information. Keywords: Musculocutaneous flap; Function; Abdominoperineal resection Funding acknowledgements: Nothing to declare. Ethics approval: Ethical approval obtained from Regional Ethics Committee, Lund, Sweden. http://dx.doi.org/10.1016/j.physio.2015.03.2123
fact, none of the participants (initially) recalled missing any appointment or deliberately not attending a session. Of these themes, two were very strong. The uncertainty regarding what physiotherapy was ‘Placing value on the unknown’ meant participants were apprehensive about turning up for appointments or had trouble prioritizing physiotherapy over other commitments. Conversely, ‘Convenience’ such as easy cheap bus routes, free parking and easy access to the physiotherapy rooms strongly encouraged attendance. Conclusion(s): Participants believed that physiotherapy was beneficial. However, uncertainty regarding the aims of physiotherapy affected participants’ ability to value its worth and consequently affected attendance. Convenience of location facilitates attendance in people living in poor socioeconomic geographical areas. Implications: A strong professional identity in conjunction with strategic marketing might improve health literacy and facilitate physiotherapy outpatient attendance. Keywords: Health inequalities; Access; Musculoskeletal physiotherapy outpatients Funding acknowledgements: This research received a University of Otago Research Grant (UORG). Ethics approval: Ethical approval was obtained from The University of Otago Ethics Committee (12/311) and from Hutt Valley District health Board (HVDHB). http://dx.doi.org/10.1016/j.physio.2015.03.2122 Research Report Poster Presentation Number: RR-PO-19-07-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 EARLY REHABILITATION AFTER PERINEAL RECONSTRUCTION WITH MUSCULOCUTANEOUS FLAPS A. Persson Skåne University Hospital, Department of Surgery, Malmö, Sweden Background: Advanced colorectal cancer can lead to abdominoperineal resection (APR) which results in large loss of perineal tissue. The pelvic floor can be reconstructed by replacing the removed tissue with a musculocutaneous flap, which also facilitates the healing process. Several reconstructive options have been described included vertical rectus abdominis musculocutaneous (VRAM) and gluteus maximus musculocutaneous flap (GM). For VRAM reconstruction, the flap is transected leaving a few cm attached to the pubic bone. Thereafter the flap is rotated and tunneled through the pelvis. This makes possible a reconstruction of the posterior vaginal wall, if needed. The abdominal wall is reinforced by a mesh to compensate the loss of stability. This procedure takes long time and involves several turnings of the patient.
eS1197
Reconstruction with a GM-flap means that 1/3 of the muscle is transected, usually based cranially and then rotated medially to fill the space. This is a less flexible method that is not likely to fill the tissue defect as well as VRAM flap. Furthermore, it could be that the extension strength of the hip is weakened due to the fact that a large part of the muscle is removed. It is, however, a less complicated operation, surgery duration is shorter and there is no damage on the abdominal wall. Few studies investigate how muscular function and strength are affected by reconstructions. To our knowledge, none of them compare these two different operative techniques regarding early rehabilitation of patients. Purpose: The aim of the study was to compare two different operative techniques by measuring early rehabilitation and wound healing. Moreover, to facilitate relevant preoperative information to patients. Methods: A retrospective study was carried out by a follow-up of hospital records of 50 patients who underwent APR with flap reconstruction between June 2010 and April 2014. 29 patients were reconstructed with GM and 21 with VRAM technique. Data was monitored regarding the first time out of bed after surgery, when achieved a certain walking distance and wound healing. All patients had the same access to guided rehabilitation. Results: Day 1: 13 patients with GM respective 5 patients with VRAM flap had been out of bed. Walk minimum 10 meters at day 2: 7 patients with GM respective 0 with VRAM flap. Walk minimum 10 meters at day 7: 23 patients with GM respective 17 with VRAM flap. Walk minimum 100 meters at day 7: 18 patients with GM respective 12 with VRAM flap. Median hospitalization was 17, 5 days for GM and respective 28 days for VRAM flap. Completely healed flap at time of discharge was 31% for GM respective 33% for VRAM technique. Conclusion(s): Our study shows that patients with GM flap reconstruction were faster in early rehabilitation and the hospitalization was shorter. No significance was found in the total amount of completely healed flap wounds. A followup regarding functional tests over a longer period would be desirable. Implications: These results are important for technical improvement and relevant preoperative patient information. Keywords: Musculocutaneous flap; Function; Abdominoperineal resection Funding acknowledgements: Nothing to declare. Ethics approval: Ethical approval obtained from Regional Ethics Committee, Lund, Sweden. http://dx.doi.org/10.1016/j.physio.2015.03.2123