Gracilis Flap Reconstruction of the Perineum: An Outcomes Analysis

Mansher Singh, Sarah Kinsley, Anne Huang, Joseph A Ricci, Thomas E Clancy, Jennifer Irani, Joel Goldberg, Elizabeth Breen, Ronald Bleday, Simon G Talbot
Journal of the American College of Surgeons 2016, 223 (4): 602-10

BACKGROUND: Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here we evaluate the role for thigh-based flaps founded on acceptable outcomes and low morbidity.

STUDY DESIGN: Consecutive patients referred to a single surgeon between January 2012 and August 2015 who underwent perineal reconstruction with a pedicled gracilis flap were identified. Patients were evaluated for routine preoperative variables and outcomes data were analyzed, including time to healing and abdominal and perineal complications.

RESULTS: Forty patients were included in the study, with a mean follow-up period of 2 years. There were no 30-day mortalities and 37 patients (92.5%) were alive at the last follow-up. Five patients (12.5%) experienced donor site complications and 16 patients (40%) had recipient site complications, including hematoma, seroma, or dehiscence. Minor complications were seen in 10 (25%) patients, and 7 (17.5%) patients had major complications. Obesity (odds ratio = 7.5; p = 0.01) and active smoking status (odds ratio = 9.3; p = 0.01) were significantly associated with minor complications, and a history of neoadjuvant chemoradiation (odds ratio = 21.4; p = 0.04) was a significant risk factor for any complication.

CONCLUSIONS: The overall complication rate with this technique is comparable with the more commonly used vertical rectus abdominis myocutaneous flap, but the potential for, and severity of, donor site complications is reduced with this technique. As such, gracilis flaps can be considered an acceptable alternative to abdominal flaps for selected perineal wounds.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.