Long-term outcomes analysis of flap-based perineal reconstruction

Area of Science:

• Reconstructive surgery
• Surgical oncology
• Plastic surgery

Background:

• Immediate flap reconstruction is beneficial for high-risk patients undergoing abdominoperineal resection and pelvic exenteration.
• Optimal flap choice and patient selection for pelvic reconstruction remain debated.
• Pedicled gracilis flaps are a potential option for pelvic reconstruction.

Purpose of the Study:

• To evaluate long-term outcomes of pedicled gracilis flaps for pelvic reconstruction.
• To identify predictors of postoperative complications in patients undergoing pelvic reconstruction with gracilis flaps.

Main Methods:

• Retrospective review of 101 patients who underwent perineal reconstruction using pedicled gracilis flaps.
• Data collected included preoperative variables and postoperative outcomes.
• Analysis focused on identifying risk factors for minor and major wound complications.

Main Results:

• A total of 101 patients underwent unilateral gracilis flap reconstruction, with a mean follow-up of 75 months.
• Major complications occurred in 7.9% (early) and 12.9% (late) of patients.
• Minor complications (wound breakdown) occurred in 32.7% of patients; anal cancer predicted early major complications, while younger age and higher BMI predicted minor complications.

Conclusions:

• Pedicled gracilis flap reconstruction demonstrates long-term success after extensive pelvic oncologic resections.
• Donor site complications were infrequent (8.9%), and perineal complications were typically manageable with local wound care.
• Gracilis flaps present an attractive alternative to abdominal-based flaps for pelvic reconstruction.