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Background <p>Anorectal cancer excisions can result in extensive perineal defects requiring soft tissue reconstruction. Increasing use of laparoscopic and robotic techniques to avoid laparotomy has necessitated a change in the approach to flap reconstruction. As a result, reconstructions using pedicled gracilis flaps have become a primary choice in perineal reconstruction in our unit. We have evaluated outcomes following gracilis-based reconstructions (GBR) and compared them with the more established vertical rectus abdominis myocutaneous (VRAM) to determine equivalence.</p> Methods <p>We compiled retrospective data (patient demographics, perioperative management &amp; post-operative complications) on patients undergoing perineal reconstructions following colorectal surgery from 2008 to 2022.</p> Results <p>There were a total of 102 colorectal perineal reconstructions with 36 VRAM flaps and 63 GBR. There were two flap failures reported within the VRAM group, and one reported with gracilis and PAP-based reconstructions. Long term complications included two perineal hernias in the VRAM cohort, one necessitating a re-do reconstruction with bilateral pedicled gracilis flaps 112 months later. No perineal hernias were identified in the GBR cohort.</p> Conclusions <p>Our unit has found the gracilis muscle flap to be a viable reconstruction option, favourable in its outcomes of perineal hernias. We report a few gracilis flap failures and favourable comparative outcomes to VRAM flap reconstruction.</p> <p>Level of evidence: Level III, therapeutic study.</p>

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Perineal reconstruction after complex pelvic anorectal surgery with the pedicled gracilis flap: a single-centre retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年5月17日

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  • Alexandra Fielding,
  • Shreya Kulkarni,
  • Sandeep Kapur,
  • Irshad Shaikh,
  • Dahlia Masud,
  • Anais Rosich-Medina,
  • Richard Haywood

摘要

Background

Anorectal cancer excisions can result in extensive perineal defects requiring soft tissue reconstruction. Increasing use of laparoscopic and robotic techniques to avoid laparotomy has necessitated a change in the approach to flap reconstruction. As a result, reconstructions using pedicled gracilis flaps have become a primary choice in perineal reconstruction in our unit. We have evaluated outcomes following gracilis-based reconstructions (GBR) and compared them with the more established vertical rectus abdominis myocutaneous (VRAM) to determine equivalence.

Methods

We compiled retrospective data (patient demographics, perioperative management & post-operative complications) on patients undergoing perineal reconstructions following colorectal surgery from 2008 to 2022.

Results

There were a total of 102 colorectal perineal reconstructions with 36 VRAM flaps and 63 GBR. There were two flap failures reported within the VRAM group, and one reported with gracilis and PAP-based reconstructions. Long term complications included two perineal hernias in the VRAM cohort, one necessitating a re-do reconstruction with bilateral pedicled gracilis flaps 112 months later. No perineal hernias were identified in the GBR cohort.

Conclusions

Our unit has found the gracilis muscle flap to be a viable reconstruction option, favourable in its outcomes of perineal hernias. We report a few gracilis flap failures and favourable comparative outcomes to VRAM flap reconstruction.

Level of evidence: Level III, therapeutic study.