Risk factors for nonhealing wounds and the clinical value of the gracilis-myofascial flap in abdomino-perineal resection: a case control study

Background: Risk factors for nonhealing wounds after abdomino-perineal resection (APR) remain inconclusive. And the pelvic floor reconstruction after APR based on gracilis-myofascial flaps (GMFs) is still controversial. This study aims to evaluate the risk factors for nonhealing wounds and demonstrate the clinical application of GMF reconstruction after APR. Methods: : APR patients at Peking University Third Hospital from December 2010 to January 2021 were analyzed retrospectively, including 81 with primary suture and 5 with GMF reconstruction. The data collected included general information, comorbidities, pre/postoperative laboratory tests, surgical data and pathological results. Univariate analysis and multifactor binary logistic regression analysis was used. Results: : There were 62 (71.2%) patients in the healing group (HG) and 24 (27.9%) patients in the nonhealing group (nHG). Old age (p = 0.011), hyperlipidemia (p = 0.042) and higher pathological Broders Grading (p = 0.048) were risk factors for nonhealing wounds. The mean hospitalization time (p = 0.002) and expense (p = 0.017) of the nHG were greater than HG. Multifactor binary logistic regression analysis showed age and hyperlipidemia were independent risk factors for nonhealing wounds after APR. Five patients with GMF reconstruction recovered well without any postoperative complications. Conclusion: Old age, hyperlipidemia and high Broders Grading are risk factors for nonhealing perineal wounds after APR, and age and hyperlipidemia are independent risk factors. GMF has satisfactory outcomes for pelvic floor reconstruction and lower probability of nonhealing wounds. Our study may provide new insights for the prevention and treatment of nonhealing perineal wounds after APR.