Reconsidering the Role of V-Y Fasciocutaneous Flaps in Abdominoperineal Resection Reconstruction With the Addition of a Pelvic Exclusion Mesh

Perineal wounds created during abdominoperineal resection present a reconstructive challenge with risk for wound complications and infections. Various reconstructive techniques, from primary closure to regional muscle transfer, have been used, but there remains no consensus on the ideal management of these perineal wounds. Gluteal fasciocutaneous advancement flap (V-Y advancement tissue transfer) reconstruction provides reliable wound closure with low complication rates. We describe our experience managing 10 patients with rectal cancer, status postneoadjuvant chemoradiation, who underwent abdominoperineal resection followed by gluteal advancement flap reconstruction and pelvic exclusion mesh with only minor nonoperative delayed wound healing, short length of stay, decreased donor site morbidity, and no ostomy complications from prone positioning. Gluteal fasciocutaneous flaps combined with pelvic exclusion mesh should be further studied to establish their role as a reconstructive modality for addressing perineal wounds.