Perineal hernia repair with synthetic mesh and bivectorial gluteus maximus myocutaneous island flap

Perineal hernia is a rare but significant complication of pelvic surgery. This report describes a unique reconstructive approach for a complex perineal hernia, combining mesh reinforcement, a modified gluteus maximus myocutaneous flap, and bone anchors - an approach not previously described. We present the case of an 88-year-old male who developed a perineal hernia with small bowel protrusion 14 years after abdominoperineal resection. Surgical repair utilized a combined synthetic mesh and a bivectorial gluteus maximus island rotation-advancement flap. This flap provided dead space obliteration, pelvic floor reinforcement via a sling-like configuration, and improved skin coverage. Bone anchors secured both the mesh and flap, ensuring stable fixation in an anatomically compromised area. The patient had an uneventful postoperative course, with no recurrence or complications during follow-up. This technique offers a promising and novel reconstructive option for challenging perineal hernias.