title: A Prospective Assessment of Surgical Risk Factors in 114 Gluteal Fold Flap Reconstructions After Oncological Vulvoperineal Resection.
abstract: OBJECTIVE
  To date, clinically relevant selection criteria have not been established for the use of the gluteal fold flap after oncological vulvoperineal resection. We prospectively assessed the surgical risk factors of this reconstructive technique in a large series.
  
  
  METHODS
  From April of 2000 through December of 2015, 114 gluteal fold flaps were used for vulvoperineal reconstruction after excision of (pre)malignant skin disorders in 75 women. The possible influence of 10 patient-related and 6 procedure-related risk factors on flap-related postoperative complications was statistically analyzed.
  
  
  RESULTS
  We observed a major complication in 13 flaps (11%) and a minor complication in 19 flaps (17%). Previous radiotherapy (P = 0.01) was associated with significantly more complications, and a rotation flap design rather than VY advancement (P = 0.02) was associated with major complications. Recurrent disease, multifocal tumor localization, incomplete removal of tumor, and bilateral flap procedure were found to be clinically relevant risk factors, but not significantly so. The same applied to recurrence of disease during postoperative follow-up.
  
  
  CONCLUSIONS
  We identified surgical risk factors for gluteal fold flap use after oncological vulvoperineal resection. These observations may potentially allow for more favorable future surgical outcomes by adaption of selection of patients or procedure.
authors.affiliation: From the Departments of *Plastic Reconstructive Surgery and †Gynecologic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Maurits
authors.initials: M
authors.lastname: Lange
authors.forename: J Joris
authors.initials: JJ
authors.lastname: Hage
authors.forename: Marc
authors.initials: M
authors.lastname: van Beurden
mesh_terms: D000328:Adult; D000368:Aged; D002081:Buttocks / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D009426:Netherlands; D010502:Perineum / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology