Applications and outcomes of gluteal flaps following rectal cancer surgery

The surgical treatment for patients with rectal cancer is associated with high morbidity, which has a serious impact on quality of life. This thesis aimed to improve postoperative outcomes for rectal cancer patients.
Part I focuses on the applicability of gluteal tissue flaps for preventing and treating pelvic complications. Chapter 3 discusses the use of gluteal fasciocutaneous flaps to treat chronic pelvic sepsis following pelvic surgery. With a high success rate of 89% in perineal wound healing, these flaps are shown to be an effective reconstruction method. Chapter 4 includes a technical note about the use of the gluteal turnover flap for reconstructing the posterior vaginal wall after abdominoperineal resection. Chapter 5 assesses the applicability of the gluteal turnover flap after primary abdominoperineal resection; although the flap did not significantly improve wound healing compared to primary closure, it did significantly lower the risk of presacral abscess (9% vs 22%) and need for drainage.
Part II examines the consequences and repair techniques for perineal hernia. Chapter 6 explores how displacement of urogenital organs after abdominoperineal resection affects function, finding that cervix displacement correlates with worse sexual function in women. A symptomatic perineal hernia can significantly worsen quality of life, as revealed in Chapter 7. Chapter 8 presents a systematic review of perineal hernia repair techniques, finding that combined mesh and tissue flap reconstruction has the lowest recurrence rate (9%) compared to biological mesh (39%), synthetic mesh (29%), and tissue flap alone (37%). A comparative multicentre study described in Chapter 9 shows that combining mesh with a gluteal flap for perineal hernia repair results in a lower recurrence rate (14%) compared to mesh-only repairs (34%).
This thesis supports the use of gluteal flaps for specific purposes.