title: Gracilis Flap Reconstruction of the Perineum: An Outcomes Analysis.
abstract: Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here we evaluate the role for thigh-based flaps founded on acceptable outcomes and low morbidity.
  
  
  
  Consecutive patients referred to a single surgeon between January 2012 and August 2015 who underwent perineal reconstruction with a pedicled gracilis flap were identified. Patients were evaluated for routine preoperative variables and outcomes data were analyzed, including time to healing and abdominal and perineal complications.
  
  
  
  Forty patients were included in the study, with a mean follow-up period of 2 years. There were no 30-day mortalities and 37 patients (92.5%) were alive at the last follow-up. Five patients (12.5%) experienced donor site complications and 16 patients (40%) had recipient site complications, including hematoma, seroma, or dehiscence. Minor complications were seen in 10 (25%) patients, and 7 (17.5%) patients had major complications. Obesity (odds ratio = 7.5; p = 0.01) and active smoking status (odds ratio = 9.3; p = 0.01) were significantly associated with minor complications, and a history of neoadjuvant chemoradiation (odds ratio = 21.4; p = 0.04) was a significant risk factor for any complication.
  
  
  
  The overall complication rate with this technique is comparable with the more commonly used vertical rectus abdominis myocutaneous flap, but the potential for, and severity of, donor site complications is reduced with this technique. As such, gracilis flaps can be considered an acceptable alternative to abdominal flaps for selected perineal wounds.
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Mansher
authors.initials: M
authors.lastname: Singh
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kinsley
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Anne
authors.initials: A
authors.lastname: Huang
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ricci
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Clancy
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Irani
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joel
authors.initials: J
authors.lastname: Goldberg
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Breen
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Bleday
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: sgtalbot@partners.org.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Talbot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D000071976:Gracilis Muscle / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013848:Thigh