Reconstructive surgery of the pelvis after surgery for rectal cancer.

The role of the reconstructive surgeon has increased with an increasingly aggressive surgical approach to locally advanced rectal carcinoma. Multiple options exist for pelvic floor reconstruction. Muscle and myocutaneous flaps for pelvic-floor reconstruction provide well vascularized tissues which may also serve as a biologic spacer. Flaps help to prevent post-radiation fistulae, small bowel obstruction, and pelvic sidewall adherence; flaps also may serve as a barrier to radiation injury. Often a more stable perineal wound closure is achieved. In cases that involve vaginal resection, flaps make neo-vaginal reconstruction possible. Pre-operative consultation with the reconstructive surgeon allows planning of complex, multi-disciplinary procedures, and facilitates patient understanding of the proposed procedure.