MANAGEMENT OF SACRAL AND PERINEAL DEFECTS FOLLOWING ABDOMINOPERINEAL RESECTION AND RADIATION WITH TRANSPELVIC MUSCLE FLAPS

PURPOSES: In this study we present our experience with treating persis tent sacral and perineal defects secondary to radiation and abdominope rineal resection with or without sacrectomy. METHODS: Fifteen consecut ive patients were treated with an inferiorly based transpelvic rectus abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15 patients achieved healing, and 7 patients had no complications. The r emaining eight patients required one or more operative debridements an d/or prolonged wound care to accomplish a healed wound. Our technique for the dissection and insetting of the transpelvic muscle flap is pre sented. CONCLUSION: The difficult postirradiated perineal and sacral w ounds can be healed with persistent surgical attention to adequate deb ridement, control of infections, and a well-vascularized muscle flap. The most satisfying aspects for patients are the discontinuance of fou l-smelling discharge, discontinuation of multiple, daily dressing chan ges, and reduction in the degree of chronic pain.