SP1.1.2Perineal reconstruction following extralevator abdominoperineal excision of rectum - Is IGAP flap a feasible option

Aim Extra-levator abdomino-perineal excision for low rectal cancer has been shown to reduce tumor perfoation rates and incidence of local recurrence when compared to a conventional abdominoperineal excision. This is however associated with increased wound complications. This study was done to evaluate the feasibility of an inferior gluteal artery flap in patients undergoing ELAPE. Methods This was retrospective analysis was done at tertiary centre for all patients who underwent an ELAPE over a period of 7 years (December 2013 to July 2020). Patient demographic, relevant co morbidities and the data regarding chemotherapy and radiotherapy were analysed. Results A Total of 33 patients underwent ELAPE with an IGAP flap wound reconstruction. The mean age was 68 (44-86) with a mean BMI of 27 (25-45). 26 patients out of 33 (82%) received neoadjuvant treatment for cancer. The mean LoS was 11 days (6-31). The perineal wound complications were graded as per Clavein Dindo classification and 56 % had no wound complications recorded. 07/33 had Grade I and 06/33 had Grade II complications. Conclusion IGAP flap closure for perineal defects, does offer the advantage of compatibility with both minimally invasive and open procedures and the avoidance of using irradiated tissue. This case series does demonstrate the feasibility of IGAP flaps as viable option to cover perineal defects following radical low rectal cancer surgery with low morbidity.