Background: Perineal wound healing complications frequently occur following abdominoperineal resection (APR) for low-lying rectal cancers, posing significant reconstructive challenges. Among various reconstructive options, gracilis muscle flaps have gained prominence due to their reliability in addressing sacral dead-space defects. Despite their popularity, decision-making criteria regarding unilateral versus bilateral gracilis flap use, supplementary adipose tissue flaps, and optimal timing for reconstruction remain inadequately defined. Materials and Methods: We conducted a retrospective single-center cohort study including 25 patients who underwent perineal reconstruction using unilateral or bilateral gracilis muscle flaps after APR complications. Variables collected encompassed demographic characteristics, preoperative treatments, operative details, and postoperative outcomes classified according to the Clavien–Dindo criteria. Additionally, we assessed the efficacy of supplementary adipose tissue flaps harvested from the ischiorectal region. Results: Among the 25 patients studied, unilateral gracilis flap reconstruction was performed in 64%, and bilateral flaps in 36%. Eleven cases (44%) received supplementary adipose tissue flaps. The overall complication rate was 44%, with 28% requiring surgical revision. Negative pressure wound therapy (NPWT) cycles pre-reconstruction significantly correlated with higher complication rates ( P = 0.013), likely reflecting underlying wound severity. Although not statistically significant, a trend indicated that a shorter interval between oncological resection and reconstructive surgery resulted in fewer complications (mean: 8.2 vs. 34.8 months; P = 0.14). Ultimately, complete healing was achieved in all patients. Conclusion: Gracilis muscle flaps, complemented by ischiorectal adipose flaps, represent an effective strategy for perineal reconstruction post-APR, though the optimal timing warrants further investigation. Although these findings are limited by the small cohort size and retrospective design, minimizing preoperative NPWT cycles and avoiding excessive delays in reconstruction may improve clinical outcomes.
Felmerer et al. (Wed,) studied this question.
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