Perineal Flap Reconstruction after Oncologic Resection

METHODS Patients who underwent abdominoperineal resections for anorectal or vulvovaginal cancer were retrospectively analyzed. We include all the patients who could not be repaired by direct closure due to excessive skin tension. We assessed the different flaps used, the surgical complications rate, wound healing, or the progression to chronic wounds. RESULTS We identified 20 patients who underwent this procedure in the last 10 years. The flaps used were all fasciocutaneous, either in a random or perforator fashion. Our first choice for defects of the external vulvar region or the perineum area was lotus petal flap (Figs. 1, 2).3 Second, we used vertical deep inferior epigastric artery perforator flap if there was a large dead space to fulfill or a defect involving the vaginal wall.4 If the deep inferior epigastric artery perforator flap would be too thick or not available according to previous abdominal surgeries, we used the anterolateral thigh flap.5 In some other cases where the lotus petal flap was not available due to poor local conditions (radiotherapy damage) and the defect was small, we used local random fasciocutaneous flaps from the gluteal or the medial thigh region.6 We reported no major complications necessitating intervention, and there were no complete flap necrosis or reconstructive failures. All the cases of partial flap loss (approximately 20%) healed by second intention without important scarring retraction. We assessed no progression to chronic wounds. Perineal Flap Reconstruction after Oncologic Resection