The partial gluteus maximus musculocutaneous turnover flap. An alternativeconcept for simultaneous reconstruction of combined defects of the posterior perineum/sacrum and the posterior vaginal wall

Three cases with posterior perineo-sacral defects are presented. One is a 5 7-year-old white female following amputation of her rectum for carcinoma, r adiation and chemotherapy with a significant residual sacral/perineal defec t and loss of the posterior vaginal wall. The two other patients had radica l pelvic exenteration after recurrent rectum carcinoma. A new myocutaneous turnover flap as a modification of the conventional glut eus maximus flap was designed to solve the particular reconstructive proble ms. The flap is based on branches of the inferior gluteal artery. The poste rior cutaneous femoral nerve and the motor branches of the inferior gluteal nerve not leading into the muscle portion of the flap are left intact. The skin island can be used for vaginal reconstruction or can be de-epithelial ised to fill perineal cavities. This new flap eventually enabled the successful reconstruction of the poste rior vaginal wall and appropriate sacral/perineal soft tissue coverage in t he first case. In the other patients the flap was used to achieve closure o f the deep through-and-through defect acutely in one case, and after a 3-we ek interval in the other.