eP672 - Perforator Based Pentagonal V-Y Advancement Skin & Subcutaneous Flap , Ideal Solution for Pelvic and Vaginal Reconstruction for Anorectal Cancers

Purpose/Background: We aim to study the utility of Perforator based Pentagonal gluteal V-Y Advancement skin and subcutaneous Flap (PPVYAF) in the reconstruction of perineal, pelvic, and vaginal defects, following abdominoperineal resection or total pelvic exenteration for colorectal and anorectal cancers.Methods/Interventions: A prospectively maintained database of patients who had PPVYAF after major pelvic-perineal surgery, between December 2014 and January 2018 was analyzed . Forty were reconstructed with PPVYAF of which 14 also had vaginal reconstruction.Results/Outcomes: Forty patients were operated, 20 male and 20 females. The mean age of the patients was 46.5 years. Thirty-three patients had reconstruction at the same time as primary surgery, 7 had salvage flap following wound dehiscence after primary closure. Neoadjuvant protocols chemo-radiotherapy was administered in 39 patients. In 11 patients posterior vaginal wall was also reconstructed and 3 patients had total vaginal reconstruction. Two patients had early postoperative wound break down which required resuturing. One patient had partial necrosis of flap which required debridement. At a mean follow up of 18 months, 34 patients were alive, none had perineal herniation, nonhealing wounds or pressure sores on the flapsConclusion/

Discussion: PPVYAF offers a simple, reliable, robust, and replicable method of addressing perineal, pelvic and vaginal defects following major anorectal resections. The simple VY design and harvest based on the understanding of perforator-based blood supply form the pillars of this flap. This facilitates early post-operative recovery, stable wound in late postoperative period and possible return of sexual function even in cases with larger resection."Bilateral VY advancement flaps for post APR defect

Planning and marking of the flaps
Perforator based mobilisation off the Gluteus muscle

Flap elevation completed
Depithelised flap for fill

Leading square of the flap used for fill
second VY flap double breasted on first filler flap

At completion of flap inset
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