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. 2019 Dec 11;7(12):e2572.
doi: 10.1097/GOX.0000000000002572. eCollection 2019 Dec.

An Algorithmic Approach to Perineal Reconstruction

Catherine M Westbom  1 , Simon G Talbot  1
Affiliations

An Algorithmic Approach to Perineal Reconstruction

Catherine M Westbom et al. Plast Reconstr Surg Glob Open. .

Abstract

Perineal wounds are one of the more challenging plastic surgical defects to reconstruct. Resections in the perineum vary in size and are frequently complicated by radiation, chemotherapy, and contamination. Furthermore, the awkward location and potential need to maintain function of the anus, urethra, and vagina and to allow comfortable sitting all contribute to the complexity of these reconstructions. In light of this complex nature, many options are available for flap coverage. In this paper, we discuss the properties of perineal defects that make each option appropriate.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Causes of perineal defect.
Fig. 2.
Fig. 2.
An abdominal donor site may be unavailable. A, Patient with morbid obesity and significant abdominal pannus with a large hernia. B, Loss of domain in a previously open abdomen previously treated with a skin graft. C, Fistula disease of the central abdomen with a history of omphalocele. D, Patient with vertical and transverse abdominal scarring, right-sided hernia, Crohn’s disease, and a colostomy on the left.
Fig. 3.
Fig. 3.
Simple defect algorithm.
Fig. 4.
Fig. 4.
Complex defect algorithm.
Fig. 5.
Fig. 5.
Gracilis muscle flap. A, Open incision approach to gracilis muscle-only flap harvest, avoiding the connection of thigh and perineum incisions. B, With careful pedicle dissection, a significant length of muscle can be tunneled to the perineum. C, Gracilis muscle inset.
Fig. 6.
Fig. 6.
Omental flap to fill abdominoperineal dead space.
Fig. 7.
Fig. 7.
A small skin graft is seen replacing the lost tissue of the posterior vaginal wall.
Fig. 8.
Fig. 8.
Bilateral thigh VY advancement flap with interposed ends.
Fig. 9.
Fig. 9.
Gluteal VY flap. A, Apparently small area surrounding the anus to be reconstructed in a patient with Paget’s disease. B, Large gluteal VY flap with minimal tension and option for possible later advancement if necessary.
Fig. 10.
Fig. 10.
Internal pudendal artery flap. A, Mesh removal and defect caused by rectovaginal fistula. B, Internal pudendal artery perforator flap. C, Inset of internal pudendal artery flap in a patient without availability of the gracilis muscles.
Fig. 11.
Fig. 11.
Myocutaneous gracilis flap. A, Defect requiring both muscular and skin components for closure, B, Myocutaneous gracilis flap.
See this image and copyright information in PMC

References

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