Reconstruction of the perineum

Area of Science:

• Reconstructive surgery
• Plastic surgery
• Oncology

Background:

• Pelvic and perineal pathologies often recur and lead to significant physical, sexual, and psychological sequelae.
• Previous surgeries or chemoirradiation complicate reconstruction in elderly and debilitated patients.
• Existing literature lacks a unified approach to perineal reconstruction, causing confusion in technique selection.

Purpose of the Study:

• To provide a structured and rational summary of reconstructive approaches for pelvic and perineal defects.
• To clarify the roles of different flap techniques in repairing specific types of defects.
• To offer an evidence-based overview for managing complex reconstructive challenges.

Main Methods:

• Review of local and regional fasciocutaneous flaps (e.g., based on internal pudendal artery territories).
• Evaluation of myocutaneous flaps (e.g., rectus, gluteus, gracilis) for pelviperineal defects, especially vaginal reconstruction.
• Discussion of muscle-sparing perforator flaps and the limited role of free tissue transfer.

Main Results:

• Fasciocutaneous flaps are suitable for external pelvic and perineal lining defects when primary closure or skin grafts are inadequate.
• Myocutaneous flaps, particularly rectus and gluteus, are advantageous for pelviperineal defects requiring bulk and resurfacing.
• Muscle-sparing and free tissue transfer techniques have specific, though limited, applications.

Conclusions:

• A multidisciplinary approach is essential for modern management of pelvic and perineal reconstruction.
• Flap selection depends on the location and extent of resection, with myocutaneous flaps often preferred for complex pelviperineal defects.
• Further large-scale studies are needed to provide more evidence-based information on outcomes of innovative reconstructive techniques.