PERINEAL RECONSTRUCTION AFTER SURGICAL EXTIRPATION OF PELVIC MALIGNANCIES USING THE TRANSPELVIC TRANSVERSE RECTUS ABDOMINAL MYOCUTANEOUS FLAP

Background: The nonhealing perineal wound is often a catastrophic comp lication after aggressive surgical extirpation of pelvic malignancies. Methods: Eleven patients underwent perineal reconstruction using an i nferiorly based transpelvic transverse rectus abdominal myocutaneous ( TRAM) flap for large nonhealing postsurgical perineal wounds. After de bridement of the perineum, the rectus muscles and their skin islands w ere mobilized, preserving their inferior epigastric blood supply. The flap was then taken through the midline abdominal incision transpelvic ally into the perineal defect. The study population was composed of th ree men and eight women ranging in age from 43 to 76 years (mean 59). The primary diagnosis was recurrent carcinoma of the rectum or anus (n = 5), recurrent squamous cell carcinoma of the vulva or cervix (n = 4 ), and recurrent sacral chordoma (n = 2). All patients had received ad juvant radiation therapy and all patients had undergone one to four pr evious attempts at perineal closure. The perineal defect ranged in siz e from 72 cm2 to 1,250 cm2 (mean 337). Results: There were no perioper ative deaths. Ten of the 11 patients (91%) had primary wound healing o f the TRAM flap, perineal wound, and donor site. One patient with recu rrent chordoma developed recurrent tumor at the suture line 4 months p ostoperatively. Conclusions: The inferiorly based transpelvic TRAM fla p is a safe and effective reconstructive technique for recalcitrant no nhealing perineal wounds after extirpation of pelvic malignancies.