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Gracilis Flap Reconstruction After Proctocolectomy for Malignancy and Inflammatory Bowel Disease
Olivia M DeLozier1, Zachary E Stiles1, David Shibata1
1Department of Surgery, 430482University of Tennessee Health Science Center, Memphis, TN, USA.
Background:
Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation.
Methods:
Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed.
Results:
Patients underwent GFR for rectal cancer (n = 28), anal cancer (n = 3), inflammatory bowel disease (n = 13), or benign fistulizing disease (n = 1). 22.2% were chronically immunosuppressed, and 66.7% underwent preoperative chemoradiation. Twenty (44.4%) patients had minor wound complications, all treated nonoperatively. Nine patients had major complications with 4 patients requiring reoperation. The 4 threatened flaps were unilateral, and all were salvaged. Donor site morbidity was minimal. Patients with major complications were older (56 vs. 71 years, P = .030), and less likely to have pelvic drains (P = .018).
Conclusion:
In high-risk perineal wounds, GFR offers durable reconstruction with acceptably low morbidity.
