Gracilis myocutaneous flap for reconstructing perineal defects resulting from radiation and radical surgery

When high-dose radiotherapy for carcinoma of the rectum, cervix, vagina or vulva fails and subsequent surgical excision by extended abdominoperineal resection or exenteration is performed, healing is often greatly delayed, for many months, and a scarred, deformed perineum results. The introduction of myocutaneous flaps opened up a new field for reconstruction of defects in a number of areas. The authors used a gracilis myocutaneous flap in 15 patients for primary reconstruction following surgical resection for failed radiotherapy of a primary carcinoma (of the rectum in 6, the cervix in 7 and the vulva in 2) and as a secondary procedure in 2 patients, 1 with an unhealed perineum 4 months after irradiation and extended abdominal resection for carcinoma of the rectum, and the other with extensive perineal necrosis following radiotherapy and chemotherapy. The operative technique, which is relatively simple, is described and illustrated. Since all patients had received radiotherapy, the myocutaneous flap was used primarily and successfully to reduce morbidity and healing time. However, even without radiotherapy, the deformity following exenteration is unacceptable and reconstruction by the method described should probably be planned as part of this operation. Not only can primary healing be expected, but the neovagina has a relatively normal appearance with satisfactory sensation and function.