An Algorithmic Anatomical Subunit Approach to Pelvic Wound Reconstruction

Area of Science:

• Reconstructive surgery
• Plastic surgery
• Surgical oncology

Background:

• High perineal dehiscence rates (up to 66%) occur after pelvic wound closure, influenced by prior radiation, dead space, and dependent positioning.
• Existing regional flaps for pelvic defects lack a systematic approach for matching to specific anatomical regions.

Purpose of the Study:

• To establish an algorithmic approach for selecting pedicled flaps based on anatomical subunits in pelvic reconstruction.
• To evaluate the efficacy and complication rates of the pelvic subunit principle in acquired pelvic defects.

Main Methods:

• Retrospective review of a prospectively maintained database of pelvic reconstructions (2010-2013) with ≥6 months follow-up.
• Categorization of pelvic defects and flap selection by anatomical subunits: anterolateral thigh (mons), gracilis (labia/introitus), vertical rectus abdominis myocutaneous (vagina/raphe), and gluteus (perianal).

Main Results:

• Forty-five flaps were performed in 30 patients (27 female, 3 male; mean age 60 years) using the subunit principle.
• Low complication rates: 3 minor dehiscences, 1 major dehiscence, 1 reoperation for abscess, and 2 partial flap losses.
• Functional outcomes included 25% of female patients resuming sexual activity after vaginal reconstruction.

Conclusions:

• The pelvic subunit principle offers an effective algorithm for selecting ideal pedicled flaps for specific anatomical regions within acquired pelvic defects.
• This principle leverages individual flap attributes for optimal regional suitability, leading to minimal complications.
• Excellent patient satisfaction with both appearance and function was reported following reconstruction using this algorithmic approach.