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Gluteal Flaps Revisited

Technical Modifications for Perineal Wound Reconstruction

Myers, Paige L., MD*; Krasniak, Peter J., BS; Day, Serena J., BS; Bossert, Ronald P., MD*

doi: 10.1097/SAP.0000000000001771
Reconstructive Surgery
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Background Abdominoperineal resection is the treatment for many anorectal malignancies. The laparotomy approach allows for harvest of the rectus abdominis muscle for perineal reconstruction. However, with increasing numbers of robotic abdominoperineal resections being performed, the morbidity associated with a laparotomy incision is avoided. We describe a modification of the previous technique of advancing bilateral fasciocutaneous gluteal flaps into the pelvic cavity for reconstruction. This operation is performed expeditiously in the prone position. The patient is spared a large anterior deficit but reaps the benefits of a robust reconstruction with minimal morbidity.

Methods A retrospective chart review was performed from July 2012 to February 2018 of our institution's electronic record database. All patients who underwent modified V-Y gluteal fasciocutaneous flaps for perineal defects were included. Patient demographics, comorbidities, and adjunctive therapies as well as outcomes and complications were analyzed.

Results A total of 31 patients (51 flaps) were identified with 100% flap survival. The total number of patients with minor complications was 42%, consisting of 4 surgical site infections (13%), 13 cases of dehiscence (42%), and 2 cases requiring return to the operating room for abscess drainage (6%). Importantly, dehiscence was defined as any wound separation, regardless of size, with an average of only 3.8 cm2. All healed with conservative management. After foregoing bolstering with synthetic mesh, the complication rate decreased from 67% to 37% (odds ratio, 3.4; P = 0.11).

Conclusions This modified technique of bilateral fasciocutaneous gluteal V-Y advancement flaps for perineal wound control is a safe and effective method of reconstructing defects.

From the *Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center; and

University of Rochester School of Medicine and Dentistry, Rochester, NY.

Received July 14, 2018, and accepted for publication, after revision October 23, 2018.

The authors have nothing to disclose.

Conflicts of interest and sources of funding: none declared.

Reprints: Ronald P. Bossert, MD, Life After Weight Loss Program, Division of Plastic Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14624. E-mail: Ronald_bossert@urmc.rochester.edu.

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