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Flap reconstruction of the pelvic floor after exenteration | CION Cancer Clinics
Flap reconstruction moves healthy muscle, sometimes with skin, from the tummy, inner thigh or buttock into the empty pelvis after exenteration. It keeps its own blood supply, so it helps the deep wound heal, especially after earlier radiotherapy. Not everyone needs one, and every flap leaves a second wound. This page explains the options, how they are chosen and what they cannot do. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is flap reconstruction after pelvic exenteration?
- Which flaps are used to rebuild the pelvic floor?
- How is a flap planned and done?
- How does a flap compare with closing the wound directly?
- What happens where the flap was taken from?
- What do families often misunderstand about flaps?
- Common questions about pelvic floor flap reconstruction
The short answer
What is flap reconstruction after pelvic exenteration?
Flap reconstruction means moving a piece of healthy tissue, usually muscle with or without skin, from another part of your body to fill the empty space left in the pelvis and close the floor of it. The tissue keeps its own blood supply, so it brings fresh, well-fed tissue into an area that often heals poorly.
Why the pelvis may need filling
Exenteration removes several organs that normally sit in the pelvis. What is left is a hollow. The small bowel can drop down into it and stick, fluid can gather in it and become infected, and the wound between the legs has nothing underneath to support it. A flap fills that hollow and gives the wound a healthy base to heal on.
Why earlier radiotherapy matters so much
Many people facing exenteration have had radiotherapy to the pelvis before, often for cervical or rectal cancer. Tissue that has been treated with radiation has a poor blood supply for years. Stitching radiated edges together is more likely to break down. Bringing in tissue from outside the treated area is one of the main reasons surgeons use a flap.
Not everyone needs a flap. Whether one is used depends on the size of the space, earlier treatment and your health.Where the tissue comes from
Which flaps are used to rebuild the pelvic floor?
Each takes tissue from a different place and leaves a different second wound. Your surgeon picks one to fit your body and the operation planned.
Tummy muscle flap
One of the long straight muscles at the front of the tummy is turned down into the pelvis with a patch of skin. Your report may call it a VRAM flap. It brings a lot of bulk.
May not suit
- People needing stomas on both sides
- Earlier tummy operations that cut that muscle
Inner thigh flap
A thin muscle from the inner thigh, called the gracilis, is tunnelled up into the pelvis. One or both sides can be used. It is smaller, so it suits smaller spaces better.
Buttock flap
Skin, fat and sometimes muscle from the buttock are moved across to close a large wound between the legs. It leaves the tummy wall alone, but the scar sits where you sit.
Omentum and mesh
The omentum, a fatty apron inside the tummy, can be laid into the pelvis without any outside wound. Some surgeons also use a sheet of mesh to close the pelvic floor.
Thin people, or those with earlier tummy surgery, may not have enough omentum to use.Not sure whether this applies to you?
Ask an oncologistFrom plan to recovery
How is a flap planned and done?
Planning before the day
The surgical oncologist and a reconstructive or plastic surgeon look at your scans and past treatment together. They decide whether a flap is needed, which one, and where any stomas will sit, because the two affect each other.
Marking
Before the operation, the surgeon may mark the skin where the flap and the stomas will go, often while you sit and stand, so that belts and clothing are considered.
During the operation
Once the organs have been removed, the flap is lifted with its blood vessels still attached, moved into the pelvis and stitched in place. This adds time to an already long operation.
The first days after
Nurses check the colour and warmth of the flap often. You may be asked to lie in certain positions and to avoid pressure on the flap and its second wound.
Side by side
How does a flap compare with closing the wound directly?
Direct closure
Flap reconstruction
The wound edges are stitched together, leaving the space empty
Healthy tissue fills the space and supports the wound
Shorter operation, one wound fewer
Longer operation, and a second wound where the flap came from
Often reasonable when the space is small and there was no earlier radiotherapy
Often preferred after radiotherapy or when the space is large
No change to the tummy wall or thigh
Some weakness or a bulge can follow at the place the tissue was taken from
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The trade-off
What happens where the flap was taken from?
Every flap leaves a second wound, called the donor site. That wound has its own healing, its own soreness and its own small risks. For most people it heals more easily than the wound between the legs, but it is one more thing to look after at home.
If the flap came from the tummy
The tummy wall on that side can be weaker afterwards. Some people develop a bulge, called a hernia, near the scar or around a stoma. You will be asked to avoid heavy lifting for a while. A support belt may be suggested once the wounds allow it.
If it came from the thigh or buttock
The leg usually works normally once healed, though the area can feel tight or numb. A buttock scar can be uncomfortable when sitting for long spells, especially on hard seats or long bus journeys home.
What a flap cannot do
A flap cannot make an operation more likely to remove all the cancer. It does not stop every wound problem either; flaps themselves can lose part of their blood supply. What it can do is lower the chance of the pelvic wound breaking down.
Commonly believed
What do families often misunderstand about flaps?
"A flap is a cosmetic extra we can skip to save money."
A pelvic floor flap is there to help the deep wound heal and to keep the bowel out of the empty pelvis. It is part of the operation plan, not a beauty step. Ask the team what they expect to happen without it.
"Moving muscle will leave her unable to walk."
The muscles used are ones the body can manage without. Most people walk normally once healed. Some weakness or tightness at the donor site is possible, and physiotherapy helps.
"If the surgeon uses a flap, the cancer must be worse."
A flap is chosen because of the size of the space and the state of the tissue, often after radiotherapy. It is not a sign of how advanced the cancer is.
"Once the flap is in, there is nothing more to watch."
The flap and the donor site both need checking while they heal. A flap that turns dark, cold or very swollen needs the team straight away.
Did you know
Where the stomas sit and which flap is used are planned together, because a tummy muscle flap and a stoma cannot share the same side of the tummy. It is worth asking to see both marked before the day.
Questions we are asked
Common questions about pelvic floor flap reconstruction
Does everyone having exenteration need a flap?
No. Some people have the wound closed directly, especially when the space left is small and there was no earlier radiotherapy. Others need a flap because the space is large or the tissue has been treated with radiation. Your surgeon will explain which applies to you and why, before the operation.
Who decides which flap is used?
The surgical oncologist and the reconstructive surgeon decide together, looking at your scans, earlier operations, where the stomas need to go and your body shape. You can ask why one flap was chosen over another, and what the second wound will mean for you at home.
Does the flap make the operation longer?
Yes. Lifting and placing a flap adds time to an operation that is already long, and a second surgeon usually joins for that part. Ask the team how long they expect the whole operation to take in your case, so the family waiting outside has a realistic idea.
Can a flap fail?
Part or all of a flap can lose its blood supply, though this is not common. Signs include the skin of the flap turning dark, cold or very swollen. Nurses check for this closely in the first days. If part of it fails, more surgery or a longer period of dressings may be needed.
Will I have a bigger scar?
You will have an extra scar where the flap was taken from, on the tummy, inner thigh or buttock. Scars fade slowly over months. Your surgeon can show you roughly where it will be before the operation, so it is not a surprise afterwards.
Can a flap also rebuild the vagina?
Sometimes. A tummy muscle flap or thigh flaps can be shaped to make a new vagina as well as fill the pelvis. This is a separate choice with its own benefits and aftercare. Ask about it at the planning stage if it matters to you, because it is hard to add later.
How long before I can lift or do housework?
It depends on which flap you had and how both wounds heal. After a tummy muscle flap, heavy lifting is usually avoided for longer to protect the tummy wall. Your surgeon will give you timings for your own recovery. Light walking starts early and helps.
Is flap reconstruction covered by schemes or insurance?
When it is part of the planned cancer operation, it is usually considered along with it. Aarogyasri, CGHS, ECHS, EHS and cashless insurance each have their own rules. Call the helpline with your card details and we will help you check what your cover includes.
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Dr. Vinay Mamidala
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Sources
- Cancer Research UK — Pelvic exenteration for cervical cancer
- National Cancer Institute — Surgery to Treat Cancer
- American Cancer Society — Surgery for Cervical Cancer
- Macmillan Cancer Support — Surgery for cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Perineal Wound Healing After ExenterationHow the wound between the legs heals, and when to callVaginal Reconstruction After ExenterationWhen a flap is also used to make a new vaginaAnterior, Posterior and Total ExenterationWhich organs are removed in each typeRecovery, Eating and Getting Back to LifeGetting strength back after a long operation
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Been told you may need a flap?
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