The use of the gracilis flap in colorectal surgery: surgical technique, results, and review of the literature

BACKGROUND: The gracilis flap is rarely used in colorectal surgery and requires a multidisciplinary surgical team including plastic surgeons. There is a paucity of data on the outcome of the gracilis flap when performed by colorectal surgeons. METHODS: A retrospective review was performed of all consecutive patients who underwent the gracilis flap at a single institution. Data collected included patient-related characteristics, indications for surgery, postoperative outcomes, and healing rates. RESULTS: Eighteen patients underwent a total of 19 flaps. The median age was 60 years. Thirteen patients (72.2%) had prior radiation therapy. The most common indication for radiation was prostate carcinoma (38.9%) and rectal or anal carcinoma (33.3%). Indications for operation were complex fistulas in 14 patients (77.8%) or wound defect closure in four patients (22.2%). Six out of 14 patients (42.9%) had failed prior fistula repair. All patients had existing stoma or underwent stoma placement at the time of the gracilis flap. Median length of stay was 5 days. Post-operative complications occurred in three patients (16.7%), and the readmission rate was 11%. Flap failure was noted in three patients (16.6%). Both patients with rectourethral fistulas healed after additional intervention. During a median follow-up time of 24 months, 11 out of the 12 temporary stomas were closed, and one was converted to a permanent colostomy. CONCLUSIONS: The gracilis flap can be successfully used for complex pelvic fistulas and perineal wounds. This study demonstrates that a colorectal surgeon with interest and expertise in this technique can perform this operation with excellent outcomes.