title: Donor site morbidity of an islanded inferior gluteal artery myocutaneous flap with vascularized fascia lata.
abstract: The perineal defect following extended abdominoperineal resection (APR) is commonly reconstructed with a pedicled vertical rectus abdominus muscle (VRAM) flap. To avoid unnecessary insult to the abdominal wall the authors have preferred an islanded inferior gluteal artery myocutaneous (IGAM) flap with vascularized fascia lata. The gluteal region is not without its own documented morbidity concerns which in this patient demographic is further complicated by nearby irradiated tissue and oncological surgery. This prospective review examines the donor site morbidity of patients following modified IGAM flaps.
  
  
  METHODS
  The records of all APR patients who had IGAM flap reconstruction performed by the senior author (August 2008-August 2012) were retrospectively reviewed for outcomes and complications, and then prospectively followed-up using a purpose-specific assessment tool. Outcome measures included (i) wound healing, (ii) posterior cutaneous nerve of the thigh (PCNT) and sciatic nerve function, (iii) gluteus maximus (GM) and tensor fascia lata (TFL) strength, and (iv) post-operative functional levels assessed using the 'Timed-Up-and-Go' (TUG) test and Oswestry Disability Index.
  
  
  RESULTS
  Of the 35 patients who satisfied the inclusion criteria 32/35 (91%) patients completed the prescribed follow-up. The average age was 62 years (range 22-82) and mean follow-up period was 10.5 (range 3-32) months. All patients had rectal cancer and received neoadjuvant chemoradiotherapy, and all except two reconstructions were performed primarily. There were 3 cases (9%) of wound dehiscence none of which were attributed to wound infection or haematoma. Scar tenderness in 5 patients (16%) was the most common post-operative complaint. PCNT hypoesthesia affected 10/32 (31%) patients while there was no significant GM or TFL weakness. Mean TUG time was 9.6 (range 3.2-15) seconds, while mean ODI score was 6.6 (range 0-40).
  
  
  CONCLUSIONS
  In spite of challenging circumstances the IGAM flap can provide appropriate wound coverage with surprisingly little donor site morbidity contrary to previous reports.
authors: Plastic and Reconstructive Surgery Unit, Western and St Vincent's Hospitals, Melbourne, Australia. ejmorri@yahoo.com
authors: E J
authors: EJ
authors: Morrison
authors: S
authors: S
authors: Shoukath
authors: P
authors: P
authors: Tansley
authors: D
authors: D
authors: Grinsell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation; D002081:Buttocks / Q000098:blood supply; D015331:Cohort Studies; D005206:Fascia Lata / Q000098:blood supply* / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000503:physiopathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D017568:Rectus Abdominis / Q000098:blood supply / Q000601:surgery / Q000637:transplantation; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D060053:Transplant Donor Site / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult