Reconstructive surgery of the pelvis after surgery for rectal cancer

The role of the reconstructive surgeon has increased with an increasingly a ggressive surgical approach to locally advanced rectal carcinoma. Multiple options exist for pelvic floor reconstruction. Muscle and myocutaneous flap s for pelvic-floor reconstruction provide well vascularized tissues which m ay also serve as a biologic spacer. Flaps help to prevent post-radiation fi stulae, small bowel obstruction, and pelvic sidewall adherence; flaps also may serve as a barrier to radiation injury. Often a more stable perineal wo und closure is achieved. In cases that involve vaginal resection, flaps mak e neo-vaginal reconstruction possible. Pre-operative consultation with the reconstructive surgeon allows planning of complex, multi-disciplinary proce dures, and facilitates patient understanding of the proposed procedure. Sem in. Surg. Oncol. 18:259-264, 2000, (C) 2000 Wiley-Liss, Inc.