Although many options are available for the management of perineal wounds after abdominoperineal resection, ranging from direct closure to flap reconstruction, treatment remains challenging. A better understanding of the aims, drawbacks and progress in perineal wound management after abdominoperineal rectal resection can help the surgeon make better choices for each patient, but it is very difficult to propose a single, optimal, evidence-based procedure for the management of pelvic exenteration. Recent progress provided by the extralevator abdominoperineal resection technique and perforator flap concepts have changed our conception of reconstruction leading to the different technical options highlighted in this review.

We present an original case of reconstruction of the abdominal wall after full-thickness parietal resection using an anterolateral thigh flap harvested with its aponeurosis; we describe the advantages of this technique which has seldom been used for this indication. A 49-year-old male presented with a recurrent dermatofibrosarcoma protuberans involving the full thickness of the upper anterior abdominal wall; after excision, a 20 x 17 cm full-thickness defect was reconstructed with an omentoplasty, a bi-layered parietal prosthesis, and a fasciocutaneous free flap with its muscular aponeurosis from the anterolateral thigh. The postoperative course was uncomplicated. Functional and aesthetic results were satisfactory. There was no tumor recurrence or postoperative incisional hernia. Many reconstructive options have been proposed, but the anterolateral thigh free flap offers the advantage of an integral reconstruction of the abdominal wall without resultant donor site morbidity and with a satisfactory cosmetic result. In our hands, this flap is the ideal choice for reconstruction of the abdominal wall after loss of substance.

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We believe that SB flaps may be a new option for reconstruction of temporal defects with the advantages of local flaps, without the inconvenience of a skin pedicle. Moreover, these flaps raise the question of the use of SB based flaps for the coverage of moderate-sized skin defects anywhere in the body, and open new fields in reconstructive surgery.