title: Gluteal fold flap in perineal reconstruction for Crohn's disease-associated fistulae.
abstract: BACKGROUND
  Crohn's disease is increasing in incidence worldwide. It is associated with many complications including fistulae, which may require surgical intervention. Occasionally, formal perineal reconstruction is needed for extensive or definitive fistula surgery. Reconstruction for inflammatory disease presents unique challenges and often calls for innovative solutions. Gluteal fold flaps (GFFs), which have been widely used in vulvo-vaginal malignancy and anorectal cancer surgery, have not hitherto been reported for Crohn's disease-associated fistulae.
  
  
  METHODS
  A 30-year-old female presented with a 5-year history of Crohn's-associated perianal and rectovaginal fistulae. She had a previous small bowel resection and ileostomy. A laparascopic pan-proctocolectomy was carried out followed by perineal reconstruction in a single stage procedure using a pedicled fasciocutaneous GFF. Seven months postoperatively, revisional surgery was carried out using the contralateral GFF due to two areas of persistent wound dehiscence. The outcome was complete resolution of the fistulae, stable wound closure and good cosmesis.
  
  
  CONCLUSIONS
  This case demonstrates that it is practical to use the GFF for perineal reconstruction following excision of complex Crohn's-associated fistulae. The flap avoids the sequelae associated with sacrifice of regional muscle flaps and specifically circumvents the unavailability of the rectus abdominis flap in slim patients or those with in-situ ileostomies. It is easy and quick to raise and does not require an intra-operative change in the patient's position. The GFF ensured well vascularised skin cover, adequate flap volume with no loss of function and low donor site morbidity.
authors.affiliation: University of Cambridge, School of Clinical Medicine, UK.
authors.forename: F
authors.initials: F
authors.lastname: Shahzad
authors.affiliation: Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: K Y
authors.initials: KY
authors.lastname: Wong
authors.affiliation: Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: M
authors.initials: M
authors.lastname: Di Candia
authors.affiliation: Peterborough City Hospital, Peterborough & Stamford Hospitals NHS Foundation Trust, UK.
authors.forename: M
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK; Postgraduate Medical Institute, Anglia Ruskin University (Chelmsford & Cambridge), UK. Electronic address: cmalata@hotmail.com.
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000328:Adult; D002081:Buttocks / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016737:Proctocolectomy, Restorative; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000601:surgery
keywords: Crohn's disease; Gluteal fold flap; Peri-anal fistulae; Perineal reconstruction; Rectovaginal fistula