eMedicine Specialties > Plastic Surgery > Trunk

Perineal Reconstruction: Follow-up

Author: Chet L Nastala, MD, Plastic, Reconstructive, and Microsurgical Associates of South Texas, PA
Contributor Information and Disclosures

Updated: Feb 27, 2009

Outcome and Prognosis

Gracilis myocutaneous reconstruction of perineal defects has the added advantages of reliability and long-standing use. Since its original description by McCraw,2 it has proved to be a time-honored workhorse for perineal reconstruction. Functional donor site morbidity is minimal, with the other thigh adductors serving to take over muscular function. In addition, the bulk of these flaps provides soft tissue fill where required. However, the bulk may limit the aesthetics of the reconstruction if the defect is more superficial.

The rectus abdominis flap provides several advantages over bilateral gracilis flap reconstruction. The robust skin paddle can be de-epithelialized for bulk or tubed for neovaginal reconstruction. This flap is well perfused by the deep inferior gastric artery and provides adequate muscle bulk to obliterate dead space. The skin island is versatile both for resurfacing the perineal region and for reconstructing the vaginal vault.

The split gluteus maximus myocutaneous flap and the gluteal thigh flap are particularly useful in resurfacing pelvic defects. They both provide a reliable, versatile reconstruction of perineal defects with low donor site morbidity. In addition, the gluteal thigh flap may remain sensate when taken with the posterior thigh sensory branch and may be de-epithelialized and tubed for distal vaginal reconstruction. "Dog ear" formation remains a problem at the medial rotation point and may require secondary revision.

Regional fasciocutaneous flaps remain useful in perineal reconstruction when the defect is superficial. When dead space obliteration is not required, they may provide a more cosmetic contour than musculocutaneous flaps. However, use caution in the irradiated field or if postoperative radiation is planned.

 


More on Perineal Reconstruction

Overview: Perineal Reconstruction
Treatment: Perineal Reconstruction
Follow-up: Perineal Reconstruction
Multimedia: Perineal Reconstruction
References
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References

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Further Reading

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Keywords

perineal reconstruction, genitourinary reconstruction, rectal cancer reconstruction, urogenital reconstruction, perineal defect, pelvic tumor, pelvic irradiation

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Contributor Information and Disclosures

Author

Chet L Nastala, MD, Plastic, Reconstructive, and Microsurgical Associates of South Texas, PA
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Orgill, MD, PhD, Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Isologen Corporation Grant/research funds Principle Investigator; Massachusetts Institute of Technology Royalty None; Brigham and Women's Hospital Royalty None; Regenesis Corporation Scientific Advisory Board Consulting; Kinetic Concepts, Inc. Expert Witness None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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