Perineal Reconstruction after Abdomino-Perineal Resection Using Gracilis Muscle Flap

Objective: To assess the efficacy of gracilis muscle flap in achieving healing of perineal defects after abdominoperineal resection (APR) for lower rectal or anal cancer.Methods: Eleven patients were subjected to gracilis muscle flap to reconstruct perineal wounds after APR. Both procedures were done simultaneously in eight patients, while delayed reconstruction was done in three patients. Postoperative complications were reported as well as healing time for all patients.Results: All patients received radiotherapy as a part of their management before the operation. Indications for operation ranged between recurrent rectal cancer, resistant anal cancer, low rectal cancer in obese patients with expected perineal wound complications, and patients with already non-healing of perineal wounds after APR. The average duration of simultaneous APR and gracilis flap reconstruction was 235.75±32.2 minutes compared to 133.3±12.6 minutes for gracilis flap reconstruction alone. Two patients had superficial donor site infection, one patient had mid-thigh numbness, all patients had minor perineal wound infection as we did not close perineal wounds and they were left to heal with secondary intention, and one patient had minor necrosis of the distal end of gracilis. All complications were treated successfully with conservative measures. The mean healing time of perineal wound was 68.18±19.78 days.Conclusions: Gracilis muscle flap is an excellent option to assist perineal wound healing after APR for both rectal cancer and anal cancer with minimal complications at both the donor site and the perineal wound.