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To compare the outcomes of two techniques for perineal and pelvic reconstruction after exenterative pelvic surgery for colorectal cancer.Twenty-four patients (14 males; median age 66 years) underwent perineal and pelvic reconstruction following exenterative surgery for advancedprimary (n = 8) and recurrent (n = 16) rectal cancers between February 2007 and October 2009. The defect was reconstructed with ORAM (n = 17) or IGAP (n = 7) flap. Perioperative outcomes and complications were assessed.Thirteen patients underwent abdominosacral resection, nine salvage abdominoperineal excision of the rectum and two pelvic exenteration. The median intra-operative time and blood loss were 9.5 (5-15) hours and 1.5 (0.3-17) litres respectively. Nineteen patients had clear margins (R0) and five had microscopic residual disease (R1). The median length of stay was 15 (11-60) days. Eight patients (seven ORAM) developed major postoperative wound complications (one abdominal skin necrosis at the donor site; one partial necrosis of the flap; one umbilicus necrosis; one partial flap loss and four major wound dehiscence (three ORAMS). Six patients (five ORAMs) developed minor wound complications. There was no significant difference between the two groups in any of the outcomes assessed (P > 0.114).Both flaps are important additions to the reconstructive armamentarium for perineal and pelvic reconstruction. It is important to choose the most appropriateprocedure on a case-by-case basis.