Gluteal Turnover Flap for Posterior Vaginal Wall Reconstruction in Rectal Cancer Surgery
Overview
This case series describes the use of a gluteal turnover flap for reconstructing posterior vaginal wall defects following en bloc resection during abdominoperineal resection (APR) in rectal cancer patients. The technique offers a minimally invasive alternative with successful healing outcomes and minimal donor site morbidity in four patients.
Background
Locally advanced or recurrent rectal cancer can invade the posterior vaginal wall, necessitating en bloc resection during APR. Small vaginal defects may be closed primarily but carry risks of dehiscence or stenosis, especially post-radiotherapy. Larger defects require well-vascularized tissue flaps to promote healing and reduce complications such as abscess or fistula formation. Traditional myocutaneous flaps involve extensive dissection and donor site morbidity, highlighting the need for less invasive reconstructive options.
Data Highlights
Characteristic
Details
Number of patients included
4
Time frame
March 2021 - November 2023
Flap size
Half-moon shaped skin island, max 2.5 cm on either buttock side
Flap thickness
2–3 cm of subcutaneous fat
Drain duration
Minimum 5 days until <10 cc/24 h output
Key Findings
The gluteal turnover flap uses adjacent buttock skin and subcutaneous tissue with minimal dissection and negligible flap failure risk.
The flap is turned inward to close posterior vaginal wall defects tension-free, with partial de-epithelialization as needed.
Fixation of the flap to vaginal fornix, lateral vaginal walls, and perineal body supports anatomical neovagina formation.
The flap fills the dead space of the resected anal canal, reducing risk of abscess and fistula.
Postoperative management includes vacuum drainage and no restrictions on sitting or mobilization.
All four patients achieved complete healing without abscess or fistula formation.
Clinical Implications
The gluteal turnover flap provides a less invasive, reliable reconstructive option for posterior vaginal wall defects after APR in rectal cancer patients. Its minimal donor site morbidity and tension-free closure may reduce postoperative complications and improve patient recovery. Surgeons should consider this technique especially when traditional myocutaneous flaps pose higher risks.
Conclusion
The gluteal turnover flap is a promising novel technique for posterior vaginal wall reconstruction in rectal cancer surgery, demonstrating successful healing and low morbidity in a small case series. Further studies may validate its broader applicability.
References
Author/Source/Year -- Various referenced studies on myocutaneous flaps and gluteal turnover flap
