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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.

Macroscopic fat embolism (MAFE) has grabbed the attention of the plastic surgery community through recent years owing to its high mortality rate. A good number of articles on its prevention during gluteal fat grafting are available in the literature. However, total prevention of this complication is a difficult goal to achieve and encountering MAFE is still a possible scenario owing to many variable factors and human elements. This review is written with the main goal of providing a treatment plan. MAFE shares a lot of similar pathophysiological and hemodynamic features with massive thrombotic pulmonary embolism (PE), especially the associated cardiopulmonary decompensation. Lessons learned from PE management were used to devise a management algorithm for MAFE. The use of extracorporeal membrane oxygenation and its potential application as a main modality of treatment for MAFE was explored. Due to the paucity of evidence for the treatment of MAFE in the literature, and its high mortality, a relative urgency was recognized to write an article on the management aspect in the form of a narrative review, making sure that every plastic surgeon who is practicing gluteal fat grafting is knowledgeable with the treatment aspect of this deadly complication.

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