Modification of the gluteal perforator-based flap for reconstruction of the posterior vagina

Vaginal reconstruction after pelvic exenteration not only affords significant psychological benefit, it also decreases the morbidity and mortality associated with pelvic exenteration. In irradiated patients filling the surgical defect with healthy, well-vascularized tissue, such as omental flaps, colonic advancements, and myocutaneous flaps, has been shown to decrease the incidence of fistulas, bowel obstructions, infections, and hemorrhage. A novel use of the gluteal perforator-based flap is described in the unique circumstance of posterior pelvic exenteration with sacrectomy.