Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum

Background: Morbidity associated with a nonhealing perineal wound is the mo st common complication following proctectomy, particularly in the setting o f recurrent carcinoma of the rectum and radiation therapy. Immediate recons truction using the gracilis myocutaneous and muscle flaps significantly red uces the incidence of major infection associated with perineal wound closur e. The purpose of this study was to assess the value of immediate reconstru ction of the perineal wound using a gracilis flap in patients undergoing ab dominoperineal resection and intraoperative radiation therapy. Methods: This study retrospectively reviewed our experience with immediate pelvic reconstruction using gracilis muscle flaps for patients undergoing r ectal extirpation and irradiation for recurrent carcinoma of the rectum. Fr om 1990 to 1995, 16 patients underwent abdominoperineal resection (APR) or pelvic exenteration accompanied by immediate wound closure with unilateral or bilateral gracilis muscle flaps. Morbidity and mortality outcomes were c ompared to those of 24 patients from our institution who, between 1988 and 1992, underwent proctectomy and irradiation for recurrent rectal carcinoma with primary closure of the perineal wound. Results: Major complications (i.e., major infection requiring hospitalizati on and/or operation) occurred in 2 (12%) of the patients with gracilis flap s versus 11 (46%) of the patients with primary closure (P =.028 by chi(2) a nalysis for flap vs. primary closure), Minor complications (i.e., persisten t sinus and subcutaneous abscess) occurred in 4 (25%) of the patients with gracilis naps versus 5 (21%) of those with primary closure. Conclusion: Immediate perineal reconstruction using the gracilis myocutaneo us flap following proctectomy and irradiation for recurrent rectal carcinom a significantly reduces the incidence of major infection associated with pe rineal wound closure.