Perineal reconstruction after rectal and anal disease using the local fascio-cutaneous-infragluteal flap: A new and reliable technique

Abstract

Significant morbidity can result from perineal wounds, particularly if the tissue has been partially devitalized after radiotherapy and extensive resection for cancer or chronic inflammation which may occur in Crohn's disease. Many different types of flaps have been used to improve healing of perineal tissue defects. The purpose of this study was to evaluate the morbidity and outcomes of reconstruction using the local fasciocutaneous infragluteal (FCI) flap. Fourteen consecutive patients undergoing local FCI flap reconstruction for perineal wounds and defects were included in the study. In 5 female patients, the defect included the dorsal wall of the vagina, which was reconstructed in 1 step. Ten patients underwent operations for anal or low rectal cancer, 3 suffered from Crohn's disease and extensive local fistula formation, and 1 young girl presented with a defect after resection of a perineal synovial sarcoma. Eleven of these patients underwent preoperative chemotherapy and either pre- or intra-operative radiotherapy. Complete healing of perineal wounds occurred in 13 of the 14 patients. There were 4 flap-related complications, including 3 patients with delayed wound healing and wound dehiscence and 1 patient with partial flap necrosis. The last patient required a second local flap for wound closure. In 2 patients, a second FCI flap was necessary because of a second tumor and a local tumor recurrence. Ambulation and normal mobility were possible after the flap procedure in all patients without restriction of activity. Four patients died during the follow-up period (median, 42.5 months) from tumor metastasis. Local FCI flap for reconstruction of large perineal defects achieves good wound healing with only moderate morbidity in most patients after extensive resection owing to cancer or Crohn's disease.