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Perforator Versus Non-perforator Flap for Perineal Reconstruction: Long-Term Comparison of Complications and Quality
Séverin R Wendelspiess1,2, Josefin T Sandstedt1,3, Julia Stoffel1,2
1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
Background:
Perineal reconstruction remains challenging due to complex anatomy, high bacterial load, and frequent postoperative complications. Extensive tissue defects after oncologic resection or severe infection commonly necessitate reconstructive procedures. Although myocutaneous flaps are widely used, perforator flaps offer advantages such as muscle preservation and reduced donor-site morbidity. Given the perineal region's critical role in defecation, urination, and sexual function, evaluating patients' quality of life (QoL) after reconstructive surgery is essential.
Methods:
This single-center cohort study evaluated postoperative complication rates and QoL after perineal reconstruction with perforator versus non-perforator flaps from 2013 to 2023. All participants were invited to complete a postoperative QoL survey.
Results:
Of all the patients, 58 % received a perforator-based and 40 % a non-perforator-based reconstruction. One patient (2.3 %) underwent a combined approach. The primary indication for perineal reconstruction (68.9 %) was defect coverage after oncologic resection. Both groups had a 50 % complication rate. Donor-site morbidity was higher in the non-perforator flap group, with all complications classified as Clavien-Dindo grade III. Additional findings were exploratory: patient satisfaction was higher in the non-perforator flap group (100 % vs 66 %), although this group had a substantially longer follow-up period (4.14 vs 1.74 years). Conversely, numerically higher QoL scores were observed in the perforator flap group.
Conclusion:
Perforator flaps demonstrated a more favorable donor-site profile, representing the most robust finding of this cohort. Observed differences in complications and patient-reported outcome measures are exploratory, and QoL continues to be insufficiently addressed in oncologic perineal reconstruction, underscoring the need for enhanced interdisciplinary collaboration.
Insights
Perforator flaps offer better donor-site outcomes in perineal reconstruction. While complication rates were similar, further research is needed to fully understand quality of life (QoL) differences between flap types.
Area of Science:
- Reconstructive surgery
- Surgical oncology
- Quality of Life research
Background:
- Perineal reconstruction presents challenges due to anatomy and infection risk.
- Defects often result from oncologic resection or severe infection.
- Perforator flaps may reduce donor-site morbidity compared to traditional myocutaneous flaps.
Purpose of the Study:
- To compare postoperative complication rates and quality of life (QoL) after perineal reconstruction using perforator versus non-perforator flaps.
- To evaluate donor-site morbidity and patient satisfaction.
- To highlight the importance of QoL assessment in perineal reconstruction.
Main Methods:
- Single-center cohort study (2013-2023).
- Evaluation of complication rates and QoL surveys post-reconstruction.
- Comparison between perforator and non-perforator flap groups.
Main Results:
- 58% perforator flaps, 40% non-perforator flaps used; 68.9% for oncologic defects.
- Both groups experienced a 50% complication rate.
- Non-perforator flaps had higher donor-site morbidity (Clavien-Dindo grade III); perforator flaps showed numerically higher QoL scores.
Conclusions:
- Perforator flaps provide a superior donor-site profile.
- Exploratory findings suggest potential differences in QoL and complications.
- Enhanced interdisciplinary collaboration is needed to improve QoL outcomes in oncologic perineal reconstruction.