Perineal perforator-based island flaps: the next frontier in perineal reconstruction.
BACKGROUND
Perineal reconstruction is a challenging prospect. Conventional flap reconstruction often involves the sacrifice of a source artery and muscle, resulting in significant donor morbidity. Perforator flaps sought to overcome this but required tedious dissection. In this article, the authors introduce a new concept in perineal reconstruction using perforator-based island flaps.


METHODS
The perineal perforator-based island flap is raised based on perforators that most commonly arise from the perineal artery. The flap is designed in the inguinal and gluteal folds in order to achieve aesthetic, tension-free primary closure of the donor site. Eleven patients underwent perineal reconstruction using this approach. Patients ranged in age from 8 to 75 years, with a female-to-male ratio of 10:1.


RESULTS
All 11 operations were performed by a single surgeon (S.Y.M.H.). There were no cases of flap loss or donor-site complications, as defined by wound infection, dehiscence, or keloid formation. All 11 patients reported excellent satisfaction with regard to donor-site aesthetics.


CONCLUSIONS
Perineal perforator-based island flaps represent one of the most successful outcomes of the perforator concept. There is no sacrifice of donor vessels or muscle and minimal donor morbidity. The flap is also easily harvested and allows for challenging free-form flap design because it is based on reliable perforators.


METHODS
Therapeutic, IV.
Seoul and Guri, Korea; and Singapore From the Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University; the Section of Plastic Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital; and the Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital.
Jeong Tae
JT
Kim
Samuel
S
Yew Ming Ho
Jin Hee
JH
Hwang
Jang Hyun
JH
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004210:Dissection; D004954:Esthetics; D005260:Female; D006119:Groin / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000639:trends; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult