Clinical Report: Outcomes of Gluteal VY Flap Reconstruction Post Extensive Pelvic Resection
Overview
This retrospective cohort study evaluates the surgical outcomes of gluteal VY flap reconstruction following extensive abdominoperineal resections, including ELAPE and total pelvic exenteration. The technique demonstrated favorable wound healing with low donor-site morbidity and effective pelvic floor reconstruction in a tertiary referral center.
Background
Extensive perineal resections, commonly performed for locally advanced rectal cancer and other pelvic malignancies, often result in large perineal defects prone to wound healing complications. The extralevator abdominoperineal excision (ELAPE) and total pelvic exenteration (TPE) improve oncological outcomes but increase the risk of perineal wound problems due to larger defects and preoperative radiotherapy. Reconstruction using well-vascularized flaps, such as the gluteal VY plasty, aims to reduce complications by filling dead space and restoring pelvic floor integrity while preserving muscle function.
Data Highlights
The study included patients undergoing gluteal VY plasty reconstruction after extensive pelvic resections between January 2017 and February 2021. Surgical technique involved unilateral or bilateral fasciocutaneous flap mobilization based on defect size, preserving vascularization from the inferior gluteal artery. Postoperative management included Air Fluidised Therapy for 14 days to optimize wound healing. Complications were graded by Clavien-Dindo classification and the Comprehensive Complication Index was calculated.
Key Findings
Gluteal VY plasty provides well-vascularized tissue with intact innervation, effectively reconstructing the pelvic floor and preventing perineal herniation.
The technique spares the gluteus maximus muscle, preserving thigh extension function and minimizing donor-site morbidity.
Postoperative use of Air Fluidised Therapy reduces pressure on the flap, facilitating wound healing and reducing complications.
Direct closure of the perineal wound is often not feasible due to large defects; the VY flap adequately fills dead space, lowering risks of infection and dehiscence.
Patients generally accept the cosmetic outcome, as the procedure does not alter the seat configuration or body silhouette.
Multidisciplinary surgical approach with experienced colorectal and plastic surgeons is critical for optimal outcomes.
Clinical Implications
Gluteal VY flap reconstruction is a reliable option for managing large perineal defects after extensive pelvic resections, offering functional and cosmetic benefits with low donor-site morbidity. Incorporating this technique into surgical practice may reduce wound complications and improve patient recovery, especially when combined with meticulous postoperative care such as Air Fluidised Therapy.
Conclusion
Gluteal VY plasty is an effective reconstructive technique following extensive abdominoperineal resections, balancing oncological safety with functional and aesthetic outcomes. Its use may enhance perineal wound healing and reduce morbidity in complex pelvic surgeries.
References
Hainsworth et al. 2012 -- Technique of Gluteal VY Plasty
