Transverse myocutaneous gracilis flap reconstruction is feasible after pelvic exenteration: 12-year surgical and oncological results

Abstract

Introduction: Pelvic exenteration (PE) is the only curative treatment for certain locally advanced intrapelvic malignancies. PE has high morbidity, and optimal reconstruction of the pelvic floor remains undetermined. Materials and methods: A retrospective chart review was performed at a tertiary university center to assess the surgical and oncological outcomes of 39 PE procedures over a 12-year period. The majority of patients (n ¼ 25) underwent transverse musculocutaneous gracilis (TMG) flap reconstruction for pelvic floor reconstruction. Results: The 1-and 5-year overall survival (OS) was 72% (95%CI 58%e86%) and 48% (95%CI 31%e65%), respectively. In multivariate analysis, lymph node metastasis (HR 3.070, p ¼ 0.024) and positive surgical margins (HR 3.928, p ¼ 0.009) were risk factors for OS. In this population, 71.8% of the patients had at least one complication. The complication rate was 65.4% and 84.6% for patients with versus without flap reconstruction, respectively (p ¼ 0.191). The length of stay was longer for patients with a major complication 16,0 ± 5,9 days vs. 29,4 ± 14,8 days, p ¼ 0,001, but complications did not affect OS. Conclusion: For selected patients, PE is a curative option for locally advanced, residual, or recurrent intrapelvic tumors. Pelvic floor and vulvovaginal defects can reliably be reconstructed using TMG flaps. TMG flaps are favored in our institution over abdominal-based flaps because the donor site morbidity is reasonable and TMG does not interfere with enterostomy.

Reconstruction of Perineal Defects: A Comparison of the Myocutaneous Gracilis and the Gluteal Fold Flap in Interdisciplinary Anorectal Tumor Resection

“…Here, we saw only one partial flap necrosis (<30%) in the MGF group that could be attributed to perfusion problems and resulted in operative debridement and repositioning of the flap. The rates of partial flap loss among MGF (6%) are comparable to those that have been reported for TMG flaps (Kaartinen et al 6%; Kiiski et al 4%) (37,41).…”

“…Anatomic studies of the proximal gracilis pedicle illustrated both septocutaneous and myocutaneous perforators traveling in a transverse direction, suggesting the skin island for the MGF should be redesigned in a horizontal fashion (6,36). To date, several authors prefer the horizontal skin island design (transverse myocutaneous gracilis flap, TMG flap) and achieve flap dimensions that are comparable to the vertical flap design (37). Further developments included a bilobed design of the MGF for perineal reconstruction (6).…”

Outcomes of the Composite Anterolateral Thigh Flap for Perineal Reconstruction After Postoncological Abdominoperineal Resection

“…10 The reconstructive armamentarium includes local, 5,[11][12][13] abdominal (vertical rectus abdominis myocutaneous (VRAM) or vertical deep inferior epigastric perforator), 9,[14][15][16] and thigh-based flaps (gracillis myocutaneous, anterolateral thigh (ALT), and posteromedial thigh). 5,6,[17][18][19][20] Pedicled VRAM are considered the gold standard after APR. This technique, however, is limited by the number and position of ostomies needed and prior abdominal surgery.…”

Usefulness of the gracilis muscle flap for reconstruction of large perineal defects following total pelvic exenteration with sacrectomy

“…Therefore, successful use of various myocutaneous flaps in the management of perineal wounds has been reported. 7,8 Several studies have reported experiences using the gracilis muscle flap (GMF), 9,10 although most of the results have not been in the setting of TPES. Here, we retrospectively reviewed our seven cases with the aim of evaluating the usefulness of GMF in the reconstruction of large perineal defects following TPES for LRRC in the pelvis.…”