2026/07/28 by Charalampos Theocharopoulos, Dimitrios N. Varvoglis, Ioannis A. Ziogas +2
paper · doi:10.1177/00031348261474188
crossref issued 2026/07/28 · crossref published 2026/07/28 · crossref published-online 2026/07/28 · crossref created 2026/07/29 · crossref deposited 2026/07/31 · crossref indexed 2026/07/31
Pelvic surgery for malignancy or infection can result in large pelvic floor defects. Standard reconstruction options may not be feasible in patients with prior radiation, significant comorbidities, and/or malnutrition. We present a low-morbidity salvage approach using an autologous peritoneal graft as a biologic pelvic partition, followed by vacuum-assisted closure, for a large contaminated perineal defect in a patient with a colocutaneous fistula following robotic abdominoperineal resection. An autologous peritoneal graft was harvested from the parietal peritoneum, including tissue from a previous incisional hernia sac, tailored to the required size, and sutured circumferentially to the margins of the defect to partition the pelvic inlet from the peritoneal cavity. A vacuum-assisted closure system was placed on postoperative day (POD) 4 and maintained until POD 43, resulting in marked wound size reduction. This technique offers a tension-free, mesh-free salvage option for selected complex perineal defects, particularly in hostile, irradiated, and contaminated fields where conventional reconstructive strategies may not be feasible.