Abstract
The patient, a 69-year-old man, had been pointed out anal fistula for 30 years but had left it alone. Biopsy was performed but malignancy was not revealed. This time he visited hospital because of the exacerbation of pain and increased discharge from a 9cm perianal mass and was admitted to the hospital to improve the nutritional condition and control the inflammation. At first colostomy and resection of abcess cavity were performed. Histological examination revealed mucinous adenocarcinoma, and we diagnosed anal fistula carcinoma. On 34 postoperative day abdominoperineal resection and reconstruction for the large defect in the perineal region using rectus abdominis flap were performed. Skin grafting was successful.
Eleven months later lymph node metastasis in left inguinal region was revealed, and operation to remove the lymph node was performed. After the operation for 3 years, there is no metastasis and recurrence.
Rectus abdominis flap can cover a wide defect in the perineal region, and can be acquired without changing the posture. We consider rectus abdominis flap as useful for reconstruction of large skin defect in perineal region.
