Muscle, myocutaneous and perforator flaps for reconstruction after abdominoperineal resection (APR) surgery: Our recent clinical experience

Abdomino- perineal resection (APR) is the most effective treatment for carcinomas located on the distal third of the rectum as well as for recurrent anal carcinomas: this procedure involves the removal of the sigmoid portion, rectum and anus in addition to regional lymph nodes. Primary intention wound closure should always be considered as first line strategy; reconstruction must be carried out planning most effective and less impairing muscular flaps (gracilis, gluteus maximus) sometimes in conjunction with fasciocutaneous overlying flaps. When the defect is anterior, we prefer employing gracilis muscle flap, mono or bilateral; when the loss of tissue is more posterior we prefer fasciocutaneous perforator flap, monolateral or bilateral, in conjunction with medial part of gluteus maximus muscle flap ( mono-or bilateral). In case of sacrectomy we usually employ mono or bilateral advanced V-Y muscolocutaneous gluteus maximus flap.