PR15 NEW TECHNIQUE IN PERINEAL AND POSTERIOR VAGINAL WALL RECONSTRUCTION: SUPERIOR AND INFERIOR GLUTEAL ARTERY PERFORATOR FLAPS

Abstract

Purpose: Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection requires replacement of dead space and restoration of function. Ideal reconstructive options include those which avoid muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue.Methodology: We present our experience with a new technique for perineal and vaginal reconstruction: superior and inferior gluteal artery perforator (SGAP or IGAP) flaps. We describe the operative technique and outcome in 14 consecutive patients. Six cases were performed as primary reconstruction and 8 cases were delayed, with all receiving preoperative radiotherapy.Results: Immediate reconstructions underwent preoperative imaging with ultrasound only, while delayed reconstructions underwent preoperative CTA. Postoperatively, patients were ambulated immediately, with all bed rest and sitting performed on the contralateral buttock or side for 4 weeks. There were no flap failures or partial flap losses, and no postoperative hernias. Four patients developed early minor wound dehiscence that was resutured in three cases. Revisional surgery was performed for reduction of three bulky flaps. All female patients reported resumption of sexual intercourse following this procedure.Conclusion: Gluteal artery perforator flaps are good options for perineal reconstruction, avoiding the donor site morbidity associated with rectus abdominis or gluteus maximus muscle harvest.