Background: Abdominoperineal resection (APR) following radiotherapy is associated
with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined
with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic
anteroposterior defects. This is used for the first time transabdominally through the pelvis
and the perineum (TAPP) in the infero-posterior directions; this technique has been described
and illustrated in this study.
Methods: Among over 90 patients who underwent perineal reconstruction between May 2004
and June 2011, six patients presented high-grade tumours invading perineum, pelvis and
sacrum, thereby resulting in a continuous anteroposterior defect. ALT þ VL TAPP reconstructions
were performed after extended APR and, subsequently, sacrectomy. Patients were examined
retrospectively to determine demographics, operative time, complications (general and
flap-related), time to complete healing and length of hospital stay. Long-term flap coverage,
flap volume stability and functional and aesthetic outcomes were assessed.
Results: Mean operating time of the reconstruction was 290 min. No deaths occurred. One patient
presented partial flap necrosis. Another patient presented a novel wound dehiscence after
flap healing, due to secondary skin dissemination of the primary tumour. Following
volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was
observed. All flaps fully covered the defects. No late complications such as fistulas or perineal
hernias occurred. Donor-site recovery was uneventful with no functional deficits.
Conclusions: The use of the ALT þ VL flap transabdominally is an innovative method to reconstruct
exceptionally complex perineal and pelvic defects extending up to the lower back. This
flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting
the pelvic floor.