Correspondence

light laparoscopy, NIR visualization and selective backfiltration to detect only tissue emitting ICG NIR fluorescence. Views of the lymphatic drainage delta are made for up to 10 min to assess the presence of sentinel nodes. Sentinel nodes were demonstrated and marked accurately in both patients, who then went on to have a standard oncological laparoscopic resection. NIR laparoscopic sentinel lymphatic mapping appears to be feasible and, if validated, may in future be combined with novel local excision techniques to effect a step-change in the management of early colon cancer.

A. Currie, A. Brigic, S. Thomas-Gibson, N. Suzuki, O. Faiz and R. H. Kennedy St Mark’s Hospital and Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK E-mail: [email protected] Received 28 January 2015; accepted 20 February 2015; Accepted Article online 17 March 2015

Supporting Information The video may be found in the online version of this article and also on the Colorectal Disease Journal YouTube and Vimeo channels: Video S1. Technical considerations in laparoscopic near-infrared sentinel lymph node mapping in early colonic neoplasia.

The vertical rectus abdominis myocutaneous flap – a video vignette doi:10.1111/codi.12918

Dear Sir, Abdominoperineal excision (APE) is most commonly required by patients with low rectal cancer. In recent years, more radical dissection has been advocated to improve local oncological control in this group [1,2]. The resulting perineal and pelvic floor defects are often large with the potential for perineal wound failure due to preoperative radiotherapy. Perineal hernia formation is also a significant risk. In our unit, we routinely use a vertical rectus myocutaneous (VRAM) flap in patients undergoing APE following neoadjuvant radiotherapy. Other specific indications include replacement of the pelvic floor, control of pelvic dead space and vaginal reconstruction. This video vignette demonstrates our method. The patient, a 68-year-old woman with low rectal cancer, was

referred to our unit after she developed a fistula-in-ano while undergoing neoadjuvant chemoradiotherapy. The operation was started by a plastic surgeon who raised the medial side of the VRAM flap to gain entry to the abdomen through the back of the rectus sheath. This technique (‘fascia-sparing’ [3]) preserves as much of the anterior rectus sheath fascia as possible adjacent to the linea alba, making fascial closure at the end of the procedure easier and more secure. Tumour excision was then completed by the colorectal team before the flap was completely elevated by the plastic surgeon, who inset the flap in the perineal wound while the colorectal team closed the abdomen and fashioned the stoma. We believe our method offers several advantages. First, fascial closure is easier and more secure when anterior sheath fascia is preserved, and second operative time is saved toward the end of the procedure, as both surgical teams are operating at the same time. We recommend this method to your readers. The video vignette accompanying this article is available at https://www.youtube.com/watch?v=Nf5CArskkzM.

T. Sahami*, A. Haque*, D. Harris*, M. Davies*, J. Beynon*, M. Evans* and P. Drew† *Department of General Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, UK and †Department of Plastic Surgery, Morriston Hospital, Heol Maes Eglwys, Swansea, UK E-mail: [email protected] Received 9 January 2015; accepted 12 January 2015; ; Accepted Article online 13 February 2015

References 1 Palmer G, Anderin C, Martling A, Holm T. Local control and survival after extralevator abdominoperineal excision for locally advanced or low rectal cancer. Colorectal Dis 2014; 16: 527–32. 2 Dalton RS, Smart NJ, Edwards TJ, Chandler I, Daniels IR. Short-term outcomes of the prone perineal approach for extra-levator abdomino-perineal excision (elAPE). Surgeon 2012; 10: 342–6. 3 Butler CE, Rodriguez-Bigas MA. Pelvic reconstruction after abdominoperineal resection: is it worth it?. Ann Surg Oncol 2005; 12: 91–4.

Supporting Information The video may be found in the online version of this article and also on the Colorectal Disease Journal YouTube and Vimeo channels: Video S1. Vertical Rectus Abdominis Myocutaneous Flap.

Colorectal Disease ª 2015 The Association of Coloproctology of Great Britain and Ireland. 17, 451–455

455

The vertical rectus abdominis myocutaneous flap--a video vignette.

The vertical rectus abdominis myocutaneous flap--a video vignette. - PDF Download Free
35KB Sizes 0 Downloads 10 Views