A 56-year-old man comes to the office because of recurrent and locally advanced rectal cancer 2 years after undergoing low anterior resection and adjuvant chemotherapy and radiation therapy. Surgical extirpation involving the external perianal skin, anus, rectum, and musculature of the pelvic floor is performed. Which of the following is the most appropriate method of perineal reconstruction in this patient? 

A 76-year-old woman presents with a diagnosis of recurrent adenocarcinoma of the rectum after chemotherapy and radiation. The planned oncologic surgical treatment will be an abdominoperineal resection to include the rectum, anus and posterior wall of the vagina, and left end colostomy. She has had a prior laparoscopic bowel resection, but no open abdominal surgeries. Which of the following is the most appropriate surgical management for her planned perineal wound? 

A 45-year-old woman with rectal cancer is scheduled to undergo abdominoperineal resection and posterior vaginectomy following neoadjuvant chemotherapy and radiation therapy. Which of the following is the most appropriate method of reconstruction of the posterior vaginal defect?

A 58-year-old man comes to the office with recurrent rectal cancer four years after undergoing low anterior resection with adjuvant radiotherapy. Open abdominoperineal resection is planned. Which of the following closure methods will most reliably reduce the incidence of perineal wound complications?