ABSTRACT
Perineal wound complications occur frequently after abdominoperineal resection (APR), particularly if radiotherapy has been given preoperatively. These complications include abscess formation, wound dehiscence, and delayed wound healing, 1, 2 3 4 5 and the incidence ranges from 25 to 60 percent. Two factors are responsible: impaired healing of the perineum secondary to radiation effects and tension at the site of wound closure. As tumor-free margins are required to minimize local recurrence, extensive resection is sometimes needed with a resulting perineal defect. The larger the perineal resection, the greater is the risk of postoperative perineal wound complications. Several techniques have been developed in an attempt to improve perineal healing. These include omentoplasty, gracilis flap, vertical rectus abdominis myocutaneous (VRAM) flap, and gluteus maximus flap. All these approaches facilitate closure of the perineal defect without undue tension by bringing in healthy and well-vascularized tissue.6 This chapter describes the authors’ technique in performing a VRAM flap for perineal reconstruction. The reader is also directed to Chapters 2.15 and 7.3 for other techniques.
