[A case of total pelvic exenteration that closed the perineal wound with a rectus abdominis myocutaneous flap for lower rectum cancer with cutaneous fistula].

The patient was a 60-year-old man with lower rectum cancer invading into the prostate gland and urinary bladder. The tumor expanded locally and made perineal cutaneous fistula. We performed a total pelvic exenteration with extended resection of perineal skin and subcutaneous tissue, followed by reconstruction using vertical rectus abdominis myocutaneous flap (VRAM flap). Although a mild pelvic abscess developed after the operation, it was controllable by drainage because the dead cavity of pelvis was relatively small due to the filing effect of VRAM flap. The VRAM flap is useful for both pelvic and perineal skin defects due to the extended resection of rectal cancer invading skin and pelvic organs.