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International Journal of Colorectal Disease

, Volume 34, Issue 3, pp 501–511 | Cite as

The adipofasciocutaneous gluteal fold perforator flap a versatile alternative choice for covering perineal defects

  • G. KoulaxouzidisEmail author
  • V. Penna
  • H. Bannasch
  • H. P. Neeff
  • P. Manegold
  • F. Aigner
  • C. Witzel
  • M. E. Kreis
  • J. Pratschke
  • G. B. Stark
  • F. M. Lampert
Original Article
  • 157 Downloads

Abstract

Aim

Perineal defects following the resection of anorectal malignancies are a reconstructive challenge. Flaps based on the rectus abdominis muscle have several drawbacks. Regional perforator flaps may be a suitable alternative. We present our experience of using the gluteal fold flap (GFF) for reconstructing perineal and pelvic defects.

Methods

We used a retrospective chart review and follow-up examinations focusing on epidemiological, oncological (procedure and outcome), and therapy-related data. This included postoperative complications and their management, length of hospital stay, and time to heal.

Results

Twenty-two GFFs (unilateral n = 8; bilateral n = 7) were performed in 15 patients (nine women and six men; anal squamous cell carcinoma n = 8; rectal adenocarcinoma n = 7; mean age 65.5 + 8.2 years) with a mean follow-up time of 1 year. Of the cases, 73.3% were a recurrent disease. Microscopic tumor resection was achieved in all but one case (93.3%). Seven cases had no complications (46.7%). Surgical complications were classified according to the Clavien-Dindo system (grades I n = 2; II n = 2; IIIb n = 4). These were mainly wound healing disorders that did not affect mobilization or discharge. The time to discharge was 22 + 9.9 days. The oncological outcomes were as follows: 53.3% of the patients had no evidence of disease, 20% had metastatic disease, 20% had local recurrent disease, and one patient (6.7%) died of other causes.

Conclusions

The GFF is a robust, reliable flap suitable for perineal and pelvic reconstruction. It can be raised quickly and easily, has an acceptable complication rate and donor site morbidity, and does not affect the abdominal wall.

Keywords

Gluteal fold flap Perineal reconstruction Pelvic reconstruction Abdominoperineal rectum excision Perforator flap 

Notes

Authorship declaration

All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors.

All authors are in agreement with the manuscript.

Compliance with ethical standards

The manuscript has not been submitted simultaneously to another journal.

Conflict of interest

The authors have no financial support or relationships to disclose that may pose a conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Plastic and Reconstructive Surgery, Department of SurgeryCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of Plastic and Hand Surgery, Faculty of MedicineUniversity of Freiburgim BreisgauGermany
  3. 3.Clinic for General and Visceral Surgery, Faculty of MedicineUniversity of Freiburgim BreisgauGermany
  4. 4.Department of SurgeryCharité-Universitätsmedizin BerlinBerlinGermany
  5. 5.Department of General, Visceral and Vascular SurgeryCharité-Universitätsmedizin BerlinBerlinGermany

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