The inferior gluteal flap in the difficult vulvar and perineal reconstruction.

OBJECTIVE: The objective was to study the feasibility and complications of the use of the inferior gluteal flap in the difficult vaginal, perineal, and vulvar reconstruction among women treated for gynecologic cancers.

METHODS: A prospective pilot study is reported. Between October 1994 and May 1996, seven patients underwent either unilateral (n = 3) or bilateral (n = 4) inferior gluteal flaps for primary reconstruction of extensive vulvar, perineal, and vaginal defects.

RESULTS: The median age of the patients was 59 years (range, 40-70). The indications for the construction of the flaps were radical resection of recurrent vulvar cancer (n = 2), radical resection of stage IV vulvar cancer (n = 2), resection of recurrent Paget's disease of the vulva (n = 1), resection of perineal recurrence of cancer of the cervix (n = 1), and resection of enteroperineal fistula following total pelvic exenteration (n = 1). The median surface area of the vulvar and perineal defect was 113 cm2 (range, 10.5-448 cm2). The median operative time for both the extirpative and the reconstructive procedures was 270 min (95-685 min) and the median estimated blood loss was 200 mL (50-950 mL). The median postoperative hospital stay was 15 days (9-29). None of the patients experienced complete graft loss. Two patients suffered necrosis of the tip of the flap that resulted in minimal wound dehiscence which healed by secondary intention, and one patient suffered graft separation which required graft revision and reconstruction. The patients were followed for a median of 11 months (3-26 months). No late complications of the reconstructive surgery were recorded.

CONCLUSIONS: The inferior gluteal flap can be safely used for the reconstruction of the difficult and extensive vulvar, perineal, and vaginal defects with excellent results.