Plastic surgical reconstruction of the perineum is often required after abdominoperineal excision of the rectum. Large perineal defects can occur after surgery for malignancy, particularly after adjuvant radiotherapy. Muscle and myocutaneous flaps can be used to close large defects, increase vascular supply to poorly healing wounds, and to reduce the incidence of major infection associated with perineal wound closure such as pelvic abscess. We report 3 cases in which gracilis flaps were used to repair large perineal defects. The defects were created after abdominoperineal resection and large perineum skin resection for rectal cancer (2 cases) and anal canal cancer. Although a mild pelvic abscess developed after the operation in one patient, it was controllable by drainage because the dead cavity of the pelvis was relatively small due to the filing effects of the gracilis flap. The gracilis flap is useful for both pelvic and perineal skin defects caused by extended resection of anorectal cancer invading the skin and pelvic organs.
