Clinical Scorecard: Gluteal Turnover Flap Effectiveness for Perineal Wound Closure Following Abdominoperineal Resection in Rectal Cancer Patients

At a Glance

Key Highlights

• Perineal wound complications occur in up to 35% of APR patients within 30 days and 10% have unhealed wounds at 1 year.
• Gluteal turnover flap is a small subcutaneous flap using adjacent buttock tissue to fill dead space without additional scars or complex dissection.
• Pilot and extended cohort studies show feasibility, safety, and potential improved wound healing compared to primary closure.

Guideline-Based Recommendations

Diagnosis

• Identify perineal wound complications clinically within 30 days and up to 1 year post-APR.
• Use Clavien–Dindo Score to grade wound complications and related interventions.

Management

• Consider gluteal turnover flap closure to fill perineal dead space after APR in eligible rectal cancer patients.
• Avoid flap closure if extended perineal skin or ischioanal fat resection is required.
• Perform flap creation by de-epithelializing a 2.5 cm wide adjacent buttock skin island and transposing subcutaneous tissue inward.
• Close perineal skin in layers over the flap with vacuum drain placement.

Monitoring & Follow-up

• Monitor perineal wound healing status at 30 days, 6 months, and 12 months postoperatively.
• Assess for symptomatic perineal hernia clinically during follow-up.
• Record any re-interventions or re-admissions related to perineal wound complications.

Risks

• Potential donor-site morbidity is minimal compared to larger myocutaneous flaps.
• No additional scars or complex vascular dissection required.
• Risk of perineal wound complications remains but may be reduced by flap closure.

Patient & Prescribing Data

Patients undergoing APR for rectal cancer without extensive perineal tissue resection

Gluteal turnover flap closure is feasible, safe, and may improve uncomplicated perineal wound healing rates compared to primary closure.

Clinical Best Practices

• Select patients carefully excluding those needing extended perineal skin or ischioanal fat resection.
• Perform flap creation with a maximum width of 2.5 cm and avoid isolating perforator vessels.
• Fix de-epithelialized dermis to contralateral levator remnant for tension-free closure.
• Use vacuum drain placement between flap and subcutaneous fat.
• Allow early mobilization postoperatively without pressure relief mattresses.

References

• BIOPEX-study on biological mesh vs primary closure
• Long-term results of biological mesh closure
• Pilot study on gluteal turnover flap feasibility and safety
• BIOPEX-2 study protocol