CR22P PERINEAL FLAP RECONSTRUCTION FOLLOWING EXTENDED RESECTION FOR PELVIC MALIGNANCY

Abstract

Purpose Extended resection for colorectal pelvic malignancy has shown good outcome but may involve extensive perineal resection necessitating plastic surgical reconstruction. The aim was to assess the indications, techniques, morbidity, and outcome of perineal flap reconstruction for extended pelvic resection.Methods Patients requiring perineal flap reconstruction following colorectal resection at a tertiary centre from 1994 to 2006 were identified from a prospective colorectal database. Details of the indication, procedure, morbidity, and outcome were obtained from the database and retrospective chart review.Results 21 patients (11 male, 10 female), median age 59 years (range 26–80) underwent perineal flap reconstruction. Indications for resection were advanced primary colorectal cancer (7), recurrent rectal carcinoma (8), recurrent anal carcinoma (3), and other pelvic malignancy (3). 18/21 patients had neoadjuvant radiotherapy. Reconstruction was by pedicled flap in 14 patients (5 gracilis flap, 7 vertical rectus abdominal muscle flap; 1 gluteal rotation flap) and latissimus dorsi free flap with microvascular anastomosis in 7 patients. Eighteen patients had immediate reconstruction and three were delayed. Five patients underwent vaginal reconstruction following posterior vaginectomy. There were four major flap complications (19%) requiring five unplanned reoperations. There were 2 minor complications (10%) requiring 1 unplanned reoperation. There were no donor site or longterm flap complications.Conclusion Perineal flap reconstruction by both pedicled and free flaps may be achieved with low morbidity following extended pelvic resection.