Oner Muharrem, Tsay Anna T, Abbas Maher A
Department of Surgery, Al-Zahra Hospital, Dubai, UAE.
Department of Surgery, Antalya City Hospital, Antalya, Turkey.
Int J Colorectal Dis. 2025 Jun 3;40(1):133. doi: 10.1007/s00384-025-04928-4.
The gracilis flap is rarely used in colorectal surgery and requires a multidisciplinary surgical team including plastic surgeons. There is a paucity of data on the outcome of the gracilis flap when performed by colorectal surgeons.
A retrospective review was performed of all consecutive patients who underwent the gracilis flap at a single institution. Data collected included patient-related characteristics, indications for surgery, postoperative outcomes, and healing rates.
Eighteen patients underwent a total of 19 flaps. The median age was 60 years. Thirteen patients (72.2%) had prior radiation therapy. The most common indication for radiation was prostate carcinoma (38.9%) and rectal or anal carcinoma (33.3%). Indications for operation were complex fistulas in 14 patients (77.8%) or wound defect closure in four patients (22.2%). Six out of 14 patients (42.9%) had failed prior fistula repair. All patients had existing stoma or underwent stoma placement at the time of the gracilis flap. Median length of stay was 5 days. Post-operative complications occurred in three patients (16.7%), and the readmission rate was 11%. Flap failure was noted in three patients (16.6%). Both patients with rectourethral fistulas healed after additional intervention. During a median follow-up time of 24 months, 11 out of the 12 temporary stomas were closed, and one was converted to a permanent colostomy.
The gracilis flap can be successfully used for complex pelvic fistulas and perineal wounds. This study demonstrates that a colorectal surgeon with interest and expertise in this technique can perform this operation with excellent outcomes.
股薄肌皮瓣在结直肠手术中很少使用，需要包括整形外科医生在内的多学科手术团队。关于结直肠外科医生进行股薄肌皮瓣手术的结果的数据很少。
对在单一机构接受股薄肌皮瓣手术的所有连续患者进行回顾性研究。收集的数据包括患者相关特征、手术指征、术后结果和愈合率。
18例患者共进行了19次皮瓣手术。中位年龄为60岁。13例患者（72.2%）曾接受过放疗。放疗最常见的指征是前列腺癌（38.9%）和直肠或肛管癌（33.3%）。手术指征为14例患者（7天）或伤口缺损闭合4例患者（22.2%）。14例患者中有6例（42.9%）先前的瘘管修复失败。所有患者在进行股薄肌皮瓣手术时都有现有的造口或接受了造口安置。中位住院时间为4天。3例患者（16.7%）发生术后并发症，再入院率为11%。3例患者（16.6%）出现皮瓣失败。2例直肠尿道瘘患者在额外干预后均愈合。在中位随访时间24个月期间，12个临时造口中有11个关闭，1个改为永久性结肠造口。
股薄肌皮瓣可成功用于复杂的盆腔瘘和会阴伤口。本研究表明，对该技术有兴趣和专业知识的结直肠外科医生可以进行该手术并取得优异的结果。
