Perforator-Based Pentagonal V-Y Advancement Skin and Subcutaneous Flap: A Solution for Pelvic and Vaginal...

We aim to study the utility of perforator-based pentagonal gluteal V-Y advancement skin and subcutaneous flap (PPVYAF) in the reconstruction of perineal, pelvic, and vaginal defects, following abdominoperineal resection or total pelvic exenteration for colorectal and anorectal cancers.

A prospectively maintained database of patients who had PPVYAF after major pelvic-perineal surgery was analyzed retrospectively between December 2014 and January 2022. A total of 110 were reconstructed with PPVYAF, of which 33 also had vaginal reconstruction.

One hundred ten patients were operated on, 61 males and 49 females. The mean age of the patients was 47.5 years. Ninety-eight patients had reconstruction at the same time as primary surgery, and 12 had salvage flaps following wound dehiscence after primary closure. Neoadjuvant protocols, such as chemoradiotherapy, were administered in 35 patients. In 15 patients, posterior vaginal wall was also reconstructed, and 18 patients had total vaginal reconstruction. Twelve patients (10.9%) had early postoperative wound breakdown, which required resuturing. Three patients (2.72%) had partial necrosis of the flap, which required debridement. At a mean follow-up of 12 months, 91 patients (82.7%) were alive; none had perineal herniation, nonhealing wounds, or pressure sores on the flaps.

PPVYAF offers a simple, reliable, robust, and replicable method of addressing perineal, pelvic, and vaginal defects following major anorectal resections. The simple V-Y design and harvest based on the understanding of perforator-based blood supply form the pillars of this flap. This facilitates early postoperative recovery, a stable wound in the late postoperative period, and possible return of sexual function even in cases with larger resection.