Gluteal Turnover Flap for Perineal Closure Post-APR in Rectal Cancer

Overview

This multicenter study evaluated the effectiveness of the gluteal turnover flap for perineal wound closure after abdominoperineal resection (APR) in rectal cancer patients. The flap technique showed promising results in reducing perineal wound complications and hernia formation compared to primary closure, with a favorable safety profile.

Background

Abdominoperineal resection for rectal cancer often results in significant perineal wound morbidity, with complications occurring in up to 35% of patients within 30 days and 10% having unhealed wounds at one year. The large perineal dead space and the effects of neo-adjuvant radiotherapy contribute to poor wound healing. Various closure techniques, including primary closure, biological mesh, and myocutaneous flaps, have been used, but no consensus exists on the optimal method. The gluteal turnover flap is a small, subcutaneous transposition flap designed to fill the dead space with well-vascularized tissue without the complexity of traditional flaps.

Data Highlights

Note: Specific numerical results were not included in the provided text.

Key Findings

• The gluteal turnover flap is a feasible and safe technique for perineal wound closure after APR.
• The flap fills the perineal dead space with well-vascularized tissue, potentially reducing fluid accumulation and abscess formation.
• Unlike myocutaneous flaps, the gluteal turnover flap does not require isolation of perforating arteries or plastic surgeon involvement.
• Patients can mobilize early postoperatively without the need for pressure relief mattresses.
• The technique avoids additional scarring by using adjacent skin and subcutaneous tissue with a maximum width of 2.5 cm.
• Preliminary data suggest improved perineal wound healing and reduced hernia rates compared to primary closure, though detailed comparative statistics were not provided.

Clinical Implications

The gluteal turnover flap offers a practical and less complex alternative to traditional myocutaneous flaps for perineal closure after APR, potentially improving wound healing outcomes and reducing perineal hernia formation. Its simplicity allows for routine use without the need for specialized plastic surgery expertise, facilitating earlier patient mobilization and possibly decreasing postoperative morbidity.

Conclusion

The gluteal turnover flap represents an effective and safe perineal closure technique following APR in rectal cancer patients, addressing the challenges of dead space and wound healing. Further randomized studies are warranted to confirm its superiority over primary closure.

References

1. BIOPEX Study Group 2017 -- Biological mesh versus primary closure after APR
2. BIOPEX Long-term Results 2021 -- Five-year perineal hernia rates
3. Pilot Study by Current Group 2019 -- Feasibility of gluteal turnover flap
4. BIOPEX-2 Trial Registration NCT04004650