Arch Hand Microsurg.  2019 Dec;24(4):402-407. 10.12790/ahm.2019.24.4.402.

Radiation Induced Perineo-Coccygeal Defect Coverage with Latissimus Dorsi Musculocutaneous Free Flap

• Oh J
• Jeon JI
• Eun S

• KMID: 2464478
• DOI: http://doi.org/10.12790/ahm.2019.24.4.402

Abstract

Perineal defect reconstruction is usually encountered in oncological conditions, trauma, or infection such as Fournier's gangrene. Reconstructive surgeons face challenges due to the complex structure and diversity of the different tissue and crucial organ components. In addition to innate characteristics, fecal contamination, difficulty of patient position to minimize trauma to the region, and suboptimal conditions for wound healing such as radiotherapy are other burdens to overcome. Common wound complications after perineal reconstruction are caused by remnant dead space, contamination, inadequate soft tissue volume, and chemoradiation-related entities after oncological resection. Classic methods such as direct closure or closure with local, regional, and distant pedicled flaps may often be unsuccessful. Free flap coverage has been reported to be successful, as the transferred tissue is outside the radiation field. We present a rare case of radiation-induced perineo-coccygeal defect covered with a free latissimus dorsi myocutaneous flap after abdominoperineal resection.

Keyword

Surgical flaps; Wound healing

MeSH Terms

Fournier Gangrene
Free Tissue Flaps*
Humans
Myocutaneous Flap
Radiotherapy
Superficial Back Muscles*
Surgeons
Surgical Flaps
Wound Healing
Wounds and Injuries

Figure

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  Fig. 1 Preoperative photograph of the perineo-coccygeal defect. Skin defect measured 8×4 cm. The dead space was 5 cm deep, covered with infectious slough and unhealthy granulation.

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  Fig. 2 Intraoperative photograph after debridement of non-viable tissue. The final skin defect was 13×5 cm. The dead space was approximately 6 cm deep.

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  Fig. 3 Intraoperative photograph of the recipient vessel. Left superior gluteal artery and veins were identified and confirmed to be patent.

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  Fig. 4 Intraoperative photograph of the donor site. Left latissimus dorsi musculocutaneous free flap was harvest in a prone position. The donor site was primarily closed.

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  Fig. 5 Intraoperative photograph of the harvest latissimus dorsi flap. The skin paddle measured 13×5 cm with muscle portion of 24×10 cm.

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  Fig. 6 Six month postoperative photograph. The wound was completely healed without complications or subjective complaints.

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