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Related Experiment Video

Updated: Mar 9, 2026

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

Published on: December 5, 2025

Perineal reconstruction with multiple perforator flaps based on anatomical divisions.

Joon P Hong¹, Chang G Kim², Hyun S Suh¹

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

|January 5, 2017

Summary

Extensive perineal defects can be effectively reconstructed using multiple pedicled perforator flaps. A simple anatomical approach ensures tension-free closure and good functional outcomes for complex cases.

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Area of Science:

Plastic Surgery
Reconstructive Surgery
Perineal Reconstruction

Background:

Perineal defect reconstruction presents challenges due to defect complexity and size.
An algorithmic approach using multiple pedicled perforator flaps is proposed for extensive defects.

Observation:

A retrospective review of 16 patients (Jan 2011-Dec 2015) with extensive perineal defects (11x10 cm² to 23x28 cm²).
Defects included Fournier's gangrene (4), extramammary Paget's disease (4), and skin cancer (8).
37 perforator flaps were utilized, guided by the perforasome theory and anatomical divisions.

Findings:

All defects achieved tension-free primary closure with an average of 2.31 flaps per patient.
Flap survival was 100%, with minor complications including temporary congestion (3) and wound dehiscence (1).
Good functional and aesthetic outcomes were observed at an average 11.06-month follow-up.

Implications:

Multiple pedicled perforator flaps provide adequate volume for extensive perineal defect coverage.
The proposed algorithmic approach simplifies reconstruction for complex perineal defects.
This method offers a reliable solution for achieving successful perineal reconstruction.