The utility of the posterior thigh flap for complex pelvic and perineal reconstruction

Background: Complex wounds of the pelvis and perineum commonly occur as a result of primary and secondary ablative procedures for colorectal and gynecologic malignancies, particularly following previous radiation therapy to these regions. In certain instances, the more traditional flaps such as the vertical rectus abdominis and gracilis flaps are either unavailable or unsuitable for the reconstruction of particular defects. The posterior thigh flap has been described previously for pelvic defects but has not become as widely accepted as other regional flaps. Methods: This study sought to retrospectively review the authors/ experience with the posterior thigh flap as an alternative to these more commonly performed transfers for difficult wounds of the perineum and pelvic structures. A total of 27 posterior thigh flaps were used in 19 patients for complex perineal wound closure. Results: Successful transfer of the posterior thigh flap was noted in 26 of 27 flaps (11 unilateral and eight bilateral), with only one flap failure (3.7 percent). Primary wound healing was ultimately achieved in all patients; however, early wound-healing complications were common (53 percent). Secondary procedures were necessary in seven patients (37 percent), with only one patient requiring a secondary flap procedure. Conclusions: The authors found the posterior thigh flap to be a useful and reliable flap for coverage of complex perineal wounds. This was particularly true for those patients in whom a laparotomy was best avoided and those who have had both urinary and fecal diversion.