Gluteal Flaps Revisited: Technical Modifications for Perineal Wound Reconstruction

Area of Science:

• Surgical Oncology
• Reconstructive Surgery
• Pelvic Floor Reconstruction

Background:

• Abdominoperineal resection is a standard treatment for anorectal malignancies.
• Traditional laparotomy for reconstruction carries significant morbidity.
• Robotic surgery for abdominoperineal resection avoids laparotomy but requires effective reconstruction methods.

Purpose of the Study:

• To describe a modified technique for perineal reconstruction using bilateral fasciocutaneous gluteal V-Y advancement flaps.
• To evaluate the safety and efficacy of this modified technique in patients undergoing abdominoperineal resection.
• To assess the complication rates associated with the modified gluteal flap reconstruction.

Main Methods:

• Retrospective chart review of patients undergoing modified V-Y gluteal fasciocutaneous flaps for perineal defects (July 2012-February 2018).
• Analysis of patient demographics, comorbidities, adjunctive therapies, outcomes, and complications.
• Comparison of complication rates before and after discontinuing synthetic mesh bolstering.

Main Results:

• 100% flap survival in 31 patients (51 flaps).
• Overall minor complication rate of 42%, including surgical site infections (13%) and dehiscence (42%).
• Complication rate decreased from 67% to 37% after omitting synthetic mesh bolstering.

Conclusions:

• The modified bilateral fasciocutaneous gluteal V-Y advancement flap technique is a safe and effective method for perineal wound reconstruction.
• This technique offers robust reconstruction with minimal morbidity, particularly beneficial in the context of robotic surgery.
• Avoiding synthetic mesh may reduce complication rates in gluteal flap reconstructions.