Reconstruction of extensive perineal defects following oncological surgery for locally recurrent rectal cancer poses functional as well as esthetic challenges. Good communication between the colorectal and reconstructive surgeon is essential to achieve a successful reconstruction. The reconstructive ladder includes a wide variety of options for the management of these defects; however, the best reconstructive option depends on defect characteristics, progression of disease, tissues involved, patient co-morbidities, past surgical history, prior radiation therapy, and the technical expertise of the reconstructive surgeon. In all cases, the necessity of skin coverage, as well as vascularized tissue to obliterate dead space, is required to close the defect and minimize the risk of complications.
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