Optimizing Long-Term Outcomes: Flap-Based Perineal Reconstruction Analysis

High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction using pedicled gracilis flaps. A total of 101 patients underwent unilateral gracilis flap reconstruction, with 7.9% developing early major complications and 12.9% developing late major complications. Minor complications occurred in 32.7% of patients, mainly minor wound breakdowns. Donor site complications were rare. Anal cancer was associated with early major complications, while younger age and elevated body mass index predicted minor wound complications.