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

Oh,  Jeongseok; Jeon,  Ji In; Eun,  Seokchan

doi:2019.24.4.402

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Case Report

Archives of Hand and Microsurgery 2019;24(4):402-407.
Published online December 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.4.402

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

Jeongseok Oh, Ji-In Jeon, Seokchan Eun

Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. sceun@snu.ac.kr

Received: 6 September 2019 • Revised: 4 October 2019 • Accepted: 28 October 2019

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.

Key Words: Surgical flaps, Wound healing

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