Total Pelvic Exenteration and Simultaneous Reconstruction of the Perineal Wound with Gracilis Muscle Flap for Advanced or Recurrent Colorectal Cancer

Fuyo Yoshimi, Yuji Asato, Yoshimasa Nakazato, Takashi Kiyokawa and Masayuki Itabashi^*

Department of Surgery and Department of Pathology^*, Ibaraki Prefectural Central Hospital and Cancer Center

Since the first report of pelvic exenteration by Brunschwig, the procedure has been accepted as a treatment modality for advanced gynecological malignancies and advanced colorectal malignancies, decreasing postoperative morality according to accumulated experience. Postoperative morbidity appears higher and postoperative hospitalization longer, however, than in other surgery for colorectal malignancies. One reason for this may be persistent perineal sinus due to fragile perineal wound repair and infection of the dead space left by multiorgan resection. We used a gracilis muscle flap to repair the perineal wound in total pelvic exenteration and studied whether the procedure decreased the length of hospitalization. Since March 1994, we conducted 9 pelvic exenterations for advanced or recurrent colorectal cancer. In 5 cases, the perineal wound was closed with a gracilis muscle flap. All 5 such cases were discharged within 30 days postoperatively. The mean postoperative hospital stay of these patients was shorter than that of the other patients whose perineal wound was simply closed with a remnant levator muscle and subcutaneous tissue. Perineal wound closure with a pedicle gracilis muscle flap after pelvic exenteration for advanced or recurrent colorectal cancer might promote earlier hospital discharge.

Key words
colorectal cancer, pelvic exenteration, gracilis muscle flap repair

Reprint requests
Fuyo Yoshimi Department of Surgery, Ibaraki Prefectural Central Hospital and Cancer Center 6528 Koibuchi, Tomobe-machi, Ibaraki 309-1793 JAPAN

Accepted
January 22, 2003

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