Outcomes of Inferior Gluteal Artery Perforator Flap in Perineal Reconstruction: A Systematic Review

A BSTRACT Flap closure facilitates tension free closure with well vascularized tissue in patients undergoing abdominoperineal resection (APR) or exenteration. Inferior gluteal artery perforator (IGAP) flaps have grown in popularity due to its ease of harvesting and avoiding the need for a large abdominal incision. This systematic review aims to summarize the latest evidence relating to perineal closure post APR with IGAP flaps, specifically relating to its 30 day morbidity. Literature search was conducted using the Pubmed, Embase, Scopus, and Web of Science databases. Terms used included “exenteration,” “abdominoperineal excision,” “abdominoperineal resection,” and “inferior gluteal artery perforator.” Abstracts from inception to October 2024 were reviewed. Only studies reported the outcomes of IGAP flaps were included. Primary outcome measure was minor and major complications associated with IGAP flaps in perineal reconstruction. Complications not requiring intervention (either radiological or surgical) was classified as minor whilst those needing intervention is major. Eight studies with a total of 249 patients were identified and included. All studies were cohort studies, with three being prospective. Total complication rate was 36.9%. Minor and major complication rates were 22.1% and 14.9%, respectively. These results were comparable to reported outcomes seen in vertical rectus abdominis myocutaneous (VRAM) flaps. IGAP flap is a good alternative to VRAM flaps for perineal closure with comparable flap related complications. Surgeons performing minimally invasive pelvic surgery should consider IGAP flap as a safe alternative to VRAM, which was the traditional work horse flap in perineal reconstruction.