Bien-Keem Tan1, Goh Terence, Chin Ho Wong, Richard Sim. 1. Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore. bienkeem@gmail.com
Abstract
BACKGROUND: Abdomino-perineal resection (APR) in the treatment of anal and low rectal cancers is associated with perineal wound problems, especially after pre-operative radiotherapy. Immediate reconstruction of defects after APR with flaps has been shown to reduce post-operative morbidity. The combined gluteal muscle and buttock fascio-cutaneous rotation flap is useful for this purpose. The dual blood supply of the gluteus maximus muscle allowed it to be split into superior and inferior halves. The inferior fibres were used to fill the pelvic cavity, whilst the superior fibres were preserved to maintain hip function. The buttock rotation flap was used for skin closure. METHODS: Eight patients who underwent APR for low rectal (n = 5) and anal (n = 3) carcinomas had immediate reconstruction with the gluteal muscle and buttock fascio-cutaneous rotation flap. The size of the perineal defects ranged from 5 × 7 to 13 × 9 cm. The indications for reconstruction were: skin defects too large for primary closure (n = 7) and previous failed flaps (n = 1). RESULTS: All the flaps survived without major complications. The minor complications were superficial wound dehiscence (n = 1) and seroma (n = 1). Both wounds healed with conservative treatment. All patients were ambulating well within 1 month with full range of active and passive motion at the hips, and completed post-operative radiotherapy without perineal wound complications. CONCLUSIONS: The gluteus maximus muscle and fascio-cutaneous buttock rotation flap was useful for reconstructing perineal defects after abdomino-perineal resection.
BACKGROUND: Abdomino-perineal resection (APR) in the treatment of anal and low rectal cancers is associated with perineal wound problems, especially after pre-operative radiotherapy. Immediate reconstruction of defects after APR with flaps has been shown to reduce post-operative morbidity. The combined gluteal muscle and buttock fascio-cutaneous rotation flap is useful for this purpose. The dual blood supply of the gluteus maximus muscle allowed it to be split into superior and inferior halves. The inferior fibres were used to fill the pelvic cavity, whilst the superior fibres were preserved to maintain hip function. The buttock rotation flap was used for skin closure. METHODS: Eight patients who underwent APR for low rectal (n = 5) and anal (n = 3) carcinomas had immediate reconstruction with the gluteal muscle and buttock fascio-cutaneous rotation flap. The size of the perineal defects ranged from 5 × 7 to 13 × 9 cm. The indications for reconstruction were: skin defects too large for primary closure (n = 7) and previous failed flaps (n = 1). RESULTS: All the flaps survived without major complications. The minor complications were superficial wound dehiscence (n = 1) and seroma (n = 1). Both wounds healed with conservative treatment. All patients were ambulating well within 1 month with full range of active and passive motion at the hips, and completed post-operative radiotherapy without perineal wound complications. CONCLUSIONS: The gluteus maximus muscle and fascio-cutaneous buttock rotation flap was useful for reconstructing perineal defects after abdomino-perineal resection.