Primary myocutaneous flap closure following resection of locally advanced pelvic malignancies

Background: Perineal wounds, created at the time of extended resection for locally advanced malignancy and following chemoradiation, are at risk of se rious complications, Methods: To determine whether immediate myocutaneous flap closure prevents complications, 57 patients treated with multimodality therapy and proctecto my; (35 perineal wounds) or sacrectomy (22 posterior wounds) were studied. Patients were categorized according to whether they underwent primary skin and pelvic closure (group 1; n = 20); primary skin and omental pelvic closu re (group 2; n = 24); or immediate myocutaneous flap closure (group 3; n = 13), Results: Groups were similar with respect to age and sex; however, group 1 had more primary tumours and required less radical surgery and chemoirradia tion than groups 2 and 3, Groups 1 and 2 experienced more complications ove rall (eight of 20, nine of 24 and three of 13 patients in groups 1, 2 and 3 respectively), more acute wound complications (seven of 20, nine of 24 and two of 13), delayed wound healing (three of 20, six of 24 and one of 13) a nd more reoperations for perineal wound problems (five of 20, seven of 24 a nd zero of 13), Patients in group 2 had a significantly longer hospital sta y than those in group 1. Flap closure (group 3) did not increase the length of stay, The routine use of primary flap closure reduced overall wound com plications (eight of 31 versus ten of 26 patients) and length of hospitaliz ation (13 versus 17 days). Conclusion: Complete wound healing was achieved in all patients; however, i mmediate myocutaneous flap closure reduced the need for readmission and reo peration.