THE INFERIOR GLUTEAL FLAP IN THE DIFFICULT VULVAR AND PERINEAL RECONSTRUCTION

Objective. The objective was to study the feasibility and complication s of the use of the inferior gluteal flap in the difficult vaginal, pe rineal, and vulvar reconstruction among women treated for gynecologic cancers. Methods. A prospective pilot study is reported. Between Octob er 1994 and May 1996, seven patients underwent either unilateral(n = 3 ) or bilateral (n = 4) inferior gluteal flaps for primary reconstructi on of extensive vulvar, perineal, and vaginal defects. Results. The me dian 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), res ection of perineal recurrence of cancer of the cervix (n = 1), and res ection of enteroperineal fistula following total pelvic exenteration ( n = 1). The median surface area of the vulvar and perineal defect was 113 cm(2) (range, 10.5-448 cm(2)). 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 mt (50-950 mt). The m edian postoperative hospital stay was 15 days (9-29). None of the pati ents experienced complete graft loss. Two patients suffered necrosis o f the tip of the flap that resulted in minimal wound dehiscence which healed by secondary intention, and one patient suffered graft separati on which required graft revision and reconstruction. The patients were followed for a median of 11 months (3-26 months). No late complicatio ns of the reconstructive surgery were recorded. Conclusions. The infer ior gluteal flap can be safely used for the reconstruction of the diff icult and extensive vulvar, perineal, and vaginal defects with excelle nt results. (C) 1997 Academic Press.