Abstract
Background
Challenges encountered during reconstruction of perineal defects following abdomino-perineal resection (AP resection) include the large volume of dead space, the risk of herniation and high rates of wound complications. There are various methods of flap reconstruction, such as the vertical rectus abdominis muscle flap. This article describes an alternative method for pelvic outlet reconstruction based on a single, pedicled, gluteus maximus muscle. This may act as a dynamic sling and restore the function of the pelvic diaphragm to support the intra-abdominal contents, to reduce the formation of a hernia.
Methods
A case series presenting four patients undergoing reconstruction following AP resection, between 2013 and 2018, was performed, in a tertiary centre with an established service providing abdominal and perineal reconstruction.
Results
A total of four patients underwent gluteal muscle flap reconstruction, following primary AP resection for rectal malignancy. Primary reconstruction was performed in two patients. The other two patients underwent delayed (or secondary) reconstruction, to improve symptomatic herniation. All four patients had initial dehiscence of their perineal wound within 4 weeks post-operatively, though no patients required surgical management for infection or exposed mesh. The two patients who underwent delayed reconstruction had complete resolution of their herniation symptoms.
Conclusions
The pedicled gluteus muscle flap provides an option for local reconstruction of large perineal defects, as it creates an innervated muscle sling to restore the support function of the pelvic diaphragm, reducing the risk of long-term hernia formation.
Level of evidence
Level V, Therapeutic
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Data Availability
All data underlying the results are available as part of the article and no additional source data are required.
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Mr N Kang conceived the article idea and was lead clinician in each case. Miss A Allan organised data collection and wrote the first draft of the manuscript, with Mr N Kang supervising. Miss E Davison wrote the second draft of the manuscript, with Mr N Kang supervising. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval not required for this retrospective study.
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The authors affirm that patients provided informed consent, both verbal and written, for sharing their data and publication of the images and cases.
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Eliza Davison, Anna Yarlini Allan, and Norbert Kang declare no conflict of interest.
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Davison, E., Allan, A.Y. & Kang, N. The use of gluteus maximus to restore the function of the pelvic diaphragm in the reconstruction of the pelvic outlet after abdomino-perineal resection: a case series. Eur J Plast Surg 46, 1219–1225 (2023). https://doi.org/10.1007/s00238-023-02127-4
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DOI: https://doi.org/10.1007/s00238-023-02127-4