Summary
Background
Abdomino-perineal resection (APR) in the treatment of anal and low rectal cancers
is associated with perineal wound problems, especially after pre-operative radiotherapy.
Immediate reconstruction of defects after APR with flaps has been shown to reduce
post-operative morbidity. The combined gluteal muscle and buttock fascio-cutaneous
rotation flap is useful for this purpose. The dual blood supply of the gluteus maximus
muscle allowed it to be split into superior and inferior halves. The inferior fibres
were used to fill the pelvic cavity, whilst the superior fibres were preserved to
maintain hip function. The buttock rotation flap was used for skin closure.
Methods
Eight patients who underwent APR for low rectal (n = 5) and anal (n = 3) carcinomas had immediate reconstruction with the gluteal muscle and buttock
fascio-cutaneous rotation flap. The size of the perineal defects ranged from 5 × 7
to 13 × 9 cm. The indications for reconstruction were: skin defects too large for
primary closure (n = 7) and previous failed flaps (n = 1).
Results
All the flaps survived without major complications. The minor complications were superficial
wound dehiscence (n = 1) and seroma (n = 1). Both wounds healed with conservative treatment. All patients were ambulating
well within 1 month with full range of active and passive motion at the hips, and
completed post-operative radiotherapy without perineal wound complications.
Conclusions
The gluteus maximus muscle and fascio-cutaneous buttock rotation flap was useful for
reconstructing perineal defects after abdomino-perineal resection.
Keywords
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Article info
Publication history
Published online: August 13, 2012
Accepted:
July 17,
2012
Received:
October 10,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
