Clinical Scorecard: A Novel Surgical Approach: Utilizing Gluteal Turnover Flap for Reconstruction of the Posterior Vaginal Wall in a Case Series
At a Glance
Category
Detail
Condition
Posterior vaginal wall defects following en bloc resection in rectal cancer surgery
Key Mechanisms
Use of a gluteal turnover flap comprising skin and subcutaneous tissue from the buttock to reconstruct the posterior vaginal wall with minimal dissection and low risk of flap failure
Target Population
Patients undergoing abdominoperineal resection (APR) for primary or locally recurrent rectal cancer with tumor invasion of the posterior vaginal wall
Care Setting
Surgical oncology and reconstructive surgery in tertiary care hospitals
Key Highlights
Gluteal turnover flap is a less invasive alternative to traditional myocutaneous flaps for posterior vaginal wall reconstruction.
The flap involves minimal dissection, negligible risk of flap failure, and allows midline closure without donor site scar.
Successful reconstruction defined by complete healing without abscess or fistula formation.
Guideline-Based Recommendations
Diagnosis
Identify posterior vaginal wall invasion in rectal cancer patients requiring en bloc resection during APR.
Management
Perform (extralevator) APR with en bloc resection of the posterior vaginal wall as indicated.
Mark and dissect a half-moon shaped gluteal turnover flap (max 2.5 cm skin island) from the buttock adjacent to the defect.
Turn the flap inward to cover the vaginal defect, de-epithelialize excess skin as needed for tensionless closure.
Fixate the flap to the posterior vaginal wall and perineal body using interrupted and continuous Vicryl 3.0 sutures.
Secure the subcutaneous flap to pelvic floor remnants and ischioanal fat to fill dead space and support neovagina.
Close subcutaneous fat and skin in layers over a vacuum drain.
Monitoring & Follow-up
Maintain vacuum drain for minimum 5 days until output is less than 10 cc/24h.
Monitor for signs of flap failure, abscess, fistula, or wound dehiscence.
No postoperative restrictions on sitting or mobilization.
Risks
Potential risks of donor site morbidity are minimized compared to traditional flaps.
Risk of dehiscence or narrowing with primary closure especially after radiotherapy.
General surgical risks related to APR and flap reconstruction.
Patient & Prescribing Data
Patients with rectal cancer invading the posterior vaginal wall undergoing APR with flap reconstruction
Gluteal turnover flap offers a reliable, less invasive reconstructive option with minimal donor site morbidity and favorable healing outcomes.
Clinical Best Practices
Use prophylactic intravenous antibiotics prior to surgery.
Position patient in lithotomy position for optimal surgical access.
Ensure tensionless closure of the vaginal defect by tailoring and partial de-epithelialization of the flap.
Fixate the flap securely to vaginal and perineal structures to prevent dead space and support anatomical positioning.
Employ vacuum drainage to reduce fluid accumulation and promote healing.
Encourage early mobilization without restrictions postoperatively.
