title: The internal pudendal artery perforator flap: free-style pedicle perforator flaps for vulva, vagina, and buttock reconstruction.
abstract: BACKGROUND
  Reconstruction of the vulva, vagina, and buttocks following cancer ablation is challenging. Restoring the shape, volume, and function is the key to the best reconstruction for these regions. Perineal reconstruction with a free-style flap based on skin perforators from the internal pudendal artery was evaluated.
  
  
  METHODS
  The internal pudendal artery perforator flap was designed based on information about the skin perforators. The flap base contained the arterial sounds, which were identified by a handheld Doppler device, on and around the ischiorectal fossa. Types of flaps used included propeller flaps, traditional transposition flaps, and V-Y advancement flaps.
  
  
  RESULTS
  Seventy-one flaps were transplanted in 45 cases. The reconstructed regions included vulvar skin in 36 cases, buttock skin in 10 cases, vagina in nine cases, anus in six cases, and pelvic cavity in six cases. The flaps were transplanted in the lithotomy or prone position. Sixty-seven of these flaps survived completely. Four flaps showed partial necrosis, but no total flap failures occurred. Thinning of the fatty tissue of the flap was performed in all cases except pelvic cavity reconstruction. An additional operation to remove bulkiness of the flaps following the initial reconstruction was required in one case. Propeller flaps, transposition flaps, and V-Y flaps were used in 35, three, and seven cases, respectively.
  
  
  CONCLUSIONS
  This study revealed that the blood circulation of this flap is reliable and that it offers suitable volume not only for vulvar, vaginal, and anal reconstruction, which requires a thin flap, but also for pelvic floor reconstruction, which requires flap volume.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Tokushima, Japan From the Department of Plastic and Reconstructive Surgery, University of Tokushima Graduate School.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hashimoto
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Abe
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakanishi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002081:Buttocks / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods*; D014625:Vaginal Neoplasms / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000601:surgery*; D055815:Young Adult