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The Utility of the Posterior Thigh Flap for Complex Pelvic and Perineal Reconstruction

Friedman, Jeffrey D. M.D.; Reece, Gregory R. M.D.; Eldor, Liron M.D.

Plastic and Reconstructive Surgery: July 2010 - Volume 126 - Issue 1 - p 146-155
doi: 10.1097/PRS.0b013e3181da8769
Reconstructive: Trunk: Original Article

Background: Complex wounds of the pelvis and perineum commonly occur as a result of primary and secondary ablative procedures for colorectal and gynecologic malignancies, particularly following previous radiation therapy to these regions. In certain instances, the more traditional flaps such as the vertical rectus abdominis and gracilis flaps are either unavailable or unsuitable for the reconstruction of particular defects. The posterior thigh flap has been described previously for pelvic defects but has not become as widely accepted as other regional flaps.

Methods: This study sought to retrospectively review the authors' experience with the posterior thigh flap as an alternative to these more commonly performed transfers for difficult wounds of the perineum and pelvic structures. A total of 27 posterior thigh flaps were used in 19 patients for complex perineal wound closure.

Results: Successful transfer of the posterior thigh flap was noted in 26 of 27 flaps (11 unilateral and eight bilateral), with only one flap failure (3.7 percent). Primary wound healing was ultimately achieved in all patients; however, early wound-healing complications were common (53 percent). Secondary procedures were necessary in seven patients (37 percent), with only one patient requiring a secondary flap procedure.

Conclusions: The authors found the posterior thigh flap to be a useful and reliable flap for coverage of complex perineal wounds. This was particularly true for those patients in whom a laparotomy was best avoided and those who have had both urinary and fecal diversion.

Houston, Texas

From the Institute for Reconstructive Surgery, The Methodist Hospital; Weill Cornell Medical School; the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; and the Division of Plastic Surgery, Baylor College of Medicine.

Received for publication September 3, 2009; accepted December 28, 2009.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Jeffrey D. Friedman, M.D., Institute for Reconstructive Surgery, The Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, Texas 77030,

©2010American Society of Plastic Surgeons