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

• Published in: International journal of colorectal disease 2019-03, Vol.34 (3), p.501-511
• Main Authors: Koulaxouzidis, G., Penna, V., Bannasch, H., Neeff, H. P., Manegold, P., Aigner, F., Witzel, C., Kreis, M. E., Pratschke, J., Stark, G. B., Lampert, F. M.
• Format: Article
• Language: English
• Subjects: Abdominal wall; Adenocarcinoma; Anorectal; Colorectal cancer; Defects; Epidemiology; Gastroenterology; Hepatology; Internal Medicine; Medicine; Medicine & Public Health; Metastases; Morbidity; Original Article; Proctology; Rectum; Squamous cell carcinoma; Surgery; Wound healing
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-018-03222-w

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.