The Colonic Mucosectomy Flap for Perineal Reconstruction after Major Pelvic Excision: A Single-Center Experience

Abstract Major pelvic excision, including extralevator abdominoperineal excision (ELAPE) and total pelvic exenteration (TPE), creates a substantial perineal defect at high risk for empty pelvis syndrome. To evaluate the feasibility and early outcomes of an autologous, donor-site-free reconstructive technique: the pedicled colonic mucosectomy flap (CMF). A retrospective single-center analysis was conducted on 5 consecutive male patients, with locally advanced rectal cancer, who underwent CMF reconstruction following ELAPE (n = 3) and TPE (n = 2). All patients received neoadjuvant therapy. Outcomes assessed included operative parameters, complications (Clavien-Dindo classification), oncological margins, and short-term sequelae. All patients achieved R0 resection. The mean operative time was 514 minutes. There were no flap-related complications. The 30-day morbidity rate was 60%, with two major (Grade 3) complications: one pelvic collection requiring percutaneous drainage and one ureteroileal anastomotic leak requiring reoperation. No perineal hernia or chronic wound issues were observed during follow-up, with a median of 4 months. The CMF is a viable and safe autologous technique for reconstructing the perineum after major pelvic excision. It effectively utilizes native tissue without donor-site morbidity and shows promise in mitigating empty pelvis complications, warranting further investigation.