[Reconstructive surgery of the anoperineal region]

The embryology and anatomy of the ano-perineal region explain the complex pathology which is difficult to treat. Six types of lesions are discussed. Congenital skin lesions: naevus or angiomas, requiring the same procedures of local autoplasty and graft as those of other regions, whenever they are extensive. Infectious lesions are dominated by Verneuil's disease, chronic hidradenitis or acne conglobata. Treatment involves wide excision which is sufficiently deep, followed by skin graft. Cancerous or pre-cancerous lesions. A distinction must be made between Bowen's disease and Paget's disease: the first is a precancerous lesion and the second is a sign of underlying carcinoma. The treatment is very different for the two conditions. Radiation dermatitis is not exceptional. Surgical treatment is required, but it is difficult. Radio-necroses can be repaired with epiplooplasty and a musculo-cutaneous flap from gluteus maximus. Post-traumatic and surgical sequelae sometimes need to be repaired by a plastic operation. Anal continence can be treated by surgical repair.