Reconstruction of large perineal defects after advanced malignant tumour resection: a simple gluteal thigh flap modification

Abstract

Reconstruction of large defects in the perineal region, after resection of advanced malignant tumours is challenging because both coverage of the perineal skin defect and adequate filling of the pelvic space must be achieved simultaneously. This manuscript introduces a simple gluteal posterior thigh flap modification for the reconstruction of such defects. A trilobed flap, in the gluteal and posterior thigh regions, was designed to be of an adequate size to repair the dermal and pelvic floor defects. After the flap was elevated and rotated 90°, the posterior thigh portion was denuded. The lateral portion of the deep gluteal fascia was incised to allow medial advancement. Thus, the flap could be easily moved to fill the defect, without tension. To evaluate the results, we reviewed 8 patients with large (>10 cm in diameter) advanced perineal carcinomas. For each patient, the defect was successfully reconstructed using the technique described. A secondary operation was required for one patient, due to atheromatosis that developed several months after the operation. Another patient developed donor site wound dehiscence and was treated with skin grafting. The described technique facilitates the effective reconstruction of large perineal defects.