Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps

Authors

  • Marcus J. D. Wagstaff B.Sc., M.B.B.S., Ph.D., M.R.C.S.,

    1. Department of Plastic Surgery, University Hospitals of Sheffield, Herries Road, Sheffield S5 7AU, UK
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  • Warren M. Rozen M.B.B.S., B.Med.Sc., PG.Dip.Surg.Anat., Ph.D.,

    1. Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, The University of Melbourne, Grattan St, Parkville 3050, Victoria, Australia
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  • Iain S. Whitaker B.A. (Hons), M.A., (Cantab) M.B.B.Chir., M.R.C.S.,

    1. Department of Plastic, Reconstructive and Burns Surgery, The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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  • Morteza Enajat B.A.,

    1. Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala 75185, Sweden
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  • Thorir Audolfsson M.D.,

    1. Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala 75185, Sweden
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  • Rafael Acosta M.D., EBOPRAS

    Corresponding author
    1. Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala 75185, Sweden
    • Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala, 75185, Sweden
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Abstract

Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection entails replacement of volume between the perineum and sacrum and restoration of a functional vagina. Ideal local reconstructive options include those which avoid functional muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue. In avoiding the donor site morbidity of other options, we describe a fasciocutaneous option for the reconstruction of the perineum and posterior vaginal wall. We present our technique of superior and inferior gluteal artery perforator (SGAP or IGAP) flaps to reconstruct such defects. Fourteen patients between 2004 and 2008 underwent 11 SGAP and three IGAP flaps. There were no flap failures or partial flap losses and no postoperative hernias. All female patients reported resumption of sexual intercourse following this procedure. Our experience in both the immediate and delayed setting is that this technique produces a good functional outcome with low donor-site morbidity. © 2009 Wiley-Liss, Inc. Microsurgery 2009.

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