Reconstruction of the Pelvic Floor With a Gluteus Maximus–Including Posterior Thigh Flap After Total Pelvic Exenteration

Background: Total pelvic exenteration (TPE) creates a massive pelvic dead space associated with a high risk of severe postoperative complications. We evaluated the clinical outcomes of pelvic floor and perineal reconstruction using a modified posterior thigh flap including the gluteus maximus muscle in patients undergoing TPE for anal canal cancer. Patients and Methods: We retrospectively reviewed 4 male patients who underwent this reconstruction at our institution between April 2020 and March 2025. Clinical outcomes, including operative details, postoperative complications, and ambulatory function (assessed through manual muscle testing), were analyzed. Results: All flaps survived completely, effectively obliterating the pelvic dead space. No major complications, such as pelvic sepsis, fistula formation, or ambulatory dysfunction, were observed at 6 months postoperatively. Hip extension strength on the reconstructed side was preserved at manual muscle testing grade 5 in all patients. Minor donor-site complications consisted of one hematoma requiring surgical hemostasis and 2 minor wound dehiscences that healed with conservative management. Conclusions: The posterior thigh flap, including the gluteus maximus, provides ample vascularized tissue to fill the pelvic cavity, spares the abdominal wall, and allows for early mobilization. In addition, releasing the muscle insertion provides greater flap mobility. This technique is a reliable reconstructive option that may minimize postoperative morbidity following TPE.