Hammock Flaps: A Novel Approach to Abdominoperineal Reconstruction.

Abstract

Extensive perineal defects resulting from abdominoperineal resection for colorectal cancer, particularly in previously irradiated fields, pose significant reconstructive challenges. Traditional methods such as vertical rectus abdominis myocutaneous or gracilis flaps are associated with donor-site morbidity and prolonged recovery. We propose a modified approach using bilateral gluteal V-Y flaps configured as a "hammock flap" to provide stable coverage and obliterate pelvic dead space. We present a case series of 4 female patients with oncological perineal defects following abdominoperineal resection. Reconstruction was performed using a double V-Y gluteal advancement flap with medial deepithelialization and anchoring to the sacrum and pubic symphysis. Perforators of the inferior gluteal artery were preserved, and the flaps were raised as island perforator flaps, allowing wide mobilization while maintaining vascular reliability. No mesh or prosthetic material was used. Specific adjustments were made in cases involving prior radiotherapy, robotic resections, or pelvic exenteration. All 4 patients achieved complete closure of the perineal defect without flap necrosis, infection, or significant dehiscence. Follow-up at 3, 6, and 12 months demonstrated stable reconstruction, satisfactory aesthetic results, and early return to daily activities. The hammock configuration provided internal mechanical support and effective obliteration of pelvic dead space without compromising abdominal wall integrity. The hammock flap is a reliable and adaptable technique for abdominoperineal reconstruction, particularly in complex or irradiated fields. It offers advantages such as reduced donor-site morbidity, shorter operative time, and satisfactory functional and aesthetic outcomes. Further studies are needed to validate its broader applicability and long-term results.