The gluteal fold flap: A versatile option for perineal reconstruction following anorectal cancer resection

Abstract

Gluteal fold flaps (GFFs) have been extensively reported for vulvo-vaginal reconstruction but there are no published series of their use for perineal reconstruction following anorectal cancer excision. In this context, abdominal myocutaneous flaps remain the method of choice but may be unavailable because of pre-existing abdominal scars, or need for a colostomy/urostomy. In addition, their abdominal wall morbidity makes them less acceptable, especially given the increasing use of laparoscopic techniques for the extirpative surgery. We document our experience using GFFs following radical anorectal cancer excision. Data were collected from a single surgeon's consecutive cases performed over a five-year period (October 2007-May 2012). The indication, surgical procedure, complications and follow-up were recorded, as was the incidence of neoadjuvant/adjuvant therapy. Ten gluteal fold fasciocutaneous flaps were performed in seven patients at the time of radical anorectal excision. The GFFs were performed alone (unilateral n=3, bilateral n=3) or in combination with a contralateral anterolateral thigh (ALT) myocutaneous flap (n=1). The indications for anorectal excision were rectal adenocarcinoma (n=3), anal squamous cell carcinoma (n=3) and anal adenocarcinoma (n=1). All flaps survived completely although two patients required further surgery, one for evacuation of a late donor site haematoma and another to close a small, persistent wound dehiscence. The mean follow-up period was 24 months (range 2-57). The GFF is a reliable, versatile and robust option for perineal reconstruction after extended anorectal excision, despite local irradiation, and should be considered for medium and selected large defects in this context.