Data Collection

In a retrospective chart analysis, we evaluated all patients that underwent APR or PE at our institution referred for plastic surgery closure between December 2008 and 2018. Data were categorized as demographic, therapy-related, or outcome-related. Patients with the need for vaginal wall reconstruction and patients that received a VRAM flap for defect coverage were excluded. Demographic data included age at the time of surgery, gender, body mass index (BMI), and concomitant diseases. The latter were summarized using the American Society of Anesthesiologists Physical Status Classification System (ASA), a six-point scale to measure the patients' preoperative global health (16). Oncosurgical data consisted of tumor histology, stage of disease, presentation status (primary or recurrent disease), the initial oncological treatment performed (radiotherapy and chemotherapy), the oncosurgical resection procedure (APR or PE), and the achieved resection margins (R0, R1, R2). Reconstructive data included the flap type (MGF or GFF, unilateral or bilateral) and operation time for defect coverage. Postoperative outcome data included all complications or adverse events occurring within 30 days of the operation (classified according to the Clavien-Dindo system), hospital stay, complications that were seen in the period 30 days after the operation until the last follow-up with the potential for long-term disability, and last follow-up. Oncological outcome data such as recurrent disease, distant metastasis and survival status were not included in the study. Informed consent and approval for the publication of photographs were obtained from the patients. The study was approved by the University of Freiburg Ethics Committee, Germany (approval number 357/19). The design and performance of the study are in accordance with the Declaration of Helsinki.