[What is the advantage of free microvascular tissue transfer after pelvic exenteration? A argument for delayed primary management].

Locoregional pelvic recurrences are amenable to re-resection even if musculoskeletal fixation is present. This report updates our experience with pelvic composite resections and microsurgical closure of the perineal cavity by nine latissimus dorsi flaps, one as a bilobed type combined with a scapula flap. All flaps survived. There was one rupture of the vascular pedicle following repositioning of the patient. Another flap healed completely, but presented a wound rupture with secondary healing in the area of the rima ani. Three major advantages to this method have been proven: (1) Healing and hospitalization could be reduced compared to conservative treatment; (2) The latissimus dorsi transfer allows stable perineal coverage and closure of dead space, preventing any pelvic herniation; (3) Performed as a delayed procedure the free tissue transfer is well tolerated by the patient.