An 81-year-old man underwent abdominoperineal (see abdominoperineal resection) resection for a low rectal carcinoma. The anticipated perineal defect in this thin individual was considered too wide for primary closure, so a gracilis musculocutaneous pedicle flap was planned.
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The pelvic peritoneum was closed from above at the conclusion of the procedure, but the levators were left to be closed from below. The edge of the levators on the right is demonstrated.
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