Perforator flaps: a new option in perineal reconstruction

Area of Science:

• Surgical reconstruction
• Plastic surgery
• Anatomy

Background:

• Methodological advancements and improved anatomical understanding have decreased complications in reconstructive surgery.
• Muscle-sparing flaps and perforator flaps offer surgeons expanded choices for reconstruction.
• Perineal reconstruction presents unique challenges due to the anatomical complexity of the region.

Purpose of the Study:

• To review current local flap options for perineal reconstruction.
• To present a decision-making algorithm for selecting appropriate flaps.
• To highlight the benefits of newer flap techniques in reducing surgical morbidity.

Main Methods:

• Literature review focusing on local flaps for perineal reconstruction.
• Analysis of surgical approaches (e.g., laparotomy, prone positioning).
• Development of a decision tree based on operative requirements and patient position.

Main Results:

• Muscle-sparing and perforator flaps are viable options for perineal reconstruction.
• The choice of flap is influenced by whether an abdominal incision (laparotomy) is necessary.
• Patient positioning during surgical excision guides the selection of donor sites (e.g., gluteal, pudendal).

Conclusions:

• Modern reconstructive techniques, including muscle-sparing and perforator flaps, enhance outcomes in perineal reconstruction.
• A systematic approach, guided by a decision tree, optimizes flap selection.
• Tailoring flap choice to surgical strategy and patient positioning is crucial for successful perineal reconstruction.