Soft Tissue Reconstruction of the Perineum: Perforator Flaps for Perineal Reconstructions

Abstract

The introduction of a multidisciplinary approach has changed the management of perineal oncology, and the perforator concept has changed the method of reconstruction. The use of local random or axial pattern flaps has become a thing of the past. The perineal region has two important roles in maintaining the body’s wellbeing, that is, an excretory and a sexual function. Malfunction or dysfunction of any one of these can affect the whole body, both physically and mentally. It is still a challenge for reconstructive surgeons to achieve the best outcome in terms of maintaining normal function and cosmetic appearance. Like the face, the perineum has a rich blood supply. In this case, branches of the femoral and iliac arteries form the rich network. These branches anastomose with each other and with corresponding vessels from the opposite side. They form circles of anastomoses around the urogenital and anal orifices. There are multiple perforators arising from these branches, and this enables reconstructing surgeons to use skin flaps based on them.