Clinical Scorecard: Donor Site Scar-Free Gluteal Transposition Flap for Perineal Defect Closure Following Abdominoperineal Resection
At a Glance
Category
Detail
Condition
Perineal wound complications and defects following abdominoperineal resection (APR)
Key Mechanisms
Use of biological mesh for pelvic floor reconstruction combined with a unilateral semicircular gluteal perforator flap (Luna flap) to obliterate dead space and promote healing
Target Population
Patients with perineal defects or complications after APR, including those with small bowel herniation through unhealed perineal wounds
Care Setting
Surgical and postoperative care in hospital and outpatient clinic settings
Key Highlights
Perineal wound problems occur in up to 47% of APR patients, with secondary hernia formation up to 26%.
The Luna flap is a donor site scar-free, semicircular gluteal perforator flap that fills perineal dead space without additional scars.
Biological mesh reconstruction combined with soft tissue coverage prevents seroma and abscess formation and promotes mesh ingrowth.
Guideline-Based Recommendations
Diagnosis
Identify perineal wound complications post-APR, including small bowel herniation through unhealed wounds.
Management
Reconstruct pelvic floor using acellular biological mesh fixed to sacrococcygeal ligaments and pelvic muscles.
Use a unilateral semicircular gluteal perforator flap (Luna flap) to obliterate dead space above the mesh without creating additional donor site scars.
Insert silicone and vacuum drains to manage purulent discharge and prevent fluid accumulation.
Monitoring & Follow-up
Postoperative monitoring of perineal wound healing and drain output.
Regular outpatient follow-up to assess wound healing and remove drains as appropriate.
Risks
Potential for purulent discharge requiring irrigation and prolonged drainage.
Risk of seroma and abscess formation if mesh is not adequately covered with soft tissue.
Patient & Prescribing Data
Patients undergoing APR with perineal wound complications including herniation and unhealed defects.
Early mobilization and sitting allowed postoperatively; Luna flap enables early return to normal activity with limited operative time increase.
Clinical Best Practices
Excise granulation and fibrotic tissue and reposition herniated bowel loops prior to reconstruction.
Use Doppler imaging to identify gluteal artery perforators for flap design.
Deepithelialize the skin island and fix the flap securely over the biological mesh to obliterate dead space.
Employ vacuum drainage between mesh and flap and in subcutaneous tissue to prevent fluid accumulation.
Allow early mobilization and sitting postoperatively while monitoring for wound healing.
