The Donut Island Flap: Avoiding Stoma Relocation in Patients With Intractable Chronic Ileostomy Leakage

Severe skin scarring after multiple abdominal surgeries may lead to serious difficulties in stoma care, especially in patients with IBD. We demonstrate the technique of Donut Island Flap that we used in a female patient with colonic Crohn’s disease that presented with intractable chronic ileostomy leakage. A relocation of the ileostomy was not possible because an alternative stoma site was not available anymore. TECHNIQUE: The scarred peristomal skin was radially excised up to a diameter of 10 cm. A pedicled anterolateral thigh perforator island flap was elevated from the right leg and was passed behind the rectus femoris muscle and through the inguinal tunnel into the defect. The ileostomy was passed through a small opening in the middle of the flap. The donor site at the thigh was closed primarily. RESULTS: No postoperative complications occurred. Three months after surgery, the ostomy care is providing no difficulties for the patient. CONCLUSION: The Donut Island Flap is a reliable and relatively simple technique to provide an adequate surrounding for ileostomy whose care is seriously impeded by severe skin scarring.