Inferior gluteal artery myocutaneous island transposition flap reconstruction of irradiated perineal defects.
BACKGROUND
With the progressive use of more radical surgical resections and pre-operative chemo-radiotherapy for locally advanced anorectal cancers, there has become an increasing need for reconstructive options that import well-vascularised tissue of sufficient bulk to the perineum. We present our technique of inferior gluteal artery myocutaneous (IGAM) transposition flaps for reconstruction after extended abdomino-perineal excision (APE) for anorectal cancer.


METHODS
Six consecutive male patients with T2/T3 rectal carcinoma underwent neoadjuvant chemo-radiotherapy followed by extended APE and immediate reconstruction with an islanded IGAM transposition flap. The operative technique and surgical outcomes were assessed with follow-up ranging from 3 to 18 months (median 5 months).


RESULTS
In all cases, there were clear histological margins with no flap failures or partial flap losses, and no post-operative hernias. There were no major wound complications, with only one superficial breakdown associated with high body mass index (BMI) and adhesive tape allergy, treated with dressings alone. There was no donor site morbidity evident following flap harvest.


CONCLUSIONS
The IGAM island transposition flap provides excellent tissue bulk, a large reliable skin paddle and a long pedicle that permits flexible positioning with tension free closure. Our successful results and high patient satisfaction make it a favourable option that should be considered when faced with this reconstructive challenge.
Boccola
Mark A
MA
Department of Plastic and Reconstructive Surgery, Western Hospital, Gordon St, Footscray, 3011 Victoria, Australia. mboccola@yahoo.com
Rozen
Warren M
WM
Ek
Edmund W
EW
Teh
Bing M
BM
Croxford
Matthew
M
Grinsell
Damien
D
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000528:radiation effects / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012004:Rectal Neoplasms / Q000532:radiotherapy; D013524:Surgical Flaps / Q000098:blood supply*