title: Evaluation of cutaneous sensibility of the internal pudendal artery perforator (IPAP) flap after perineal reconstructions.
abstract: BACKGROUND
  In oncological perineal reconstructions, the internal pudendal artery perforator (IPAP) flap is our flap of choice, supplied by perforator vessels from the internal pudendal artery and innervated by branches from the pudendal nerve and the posterior femoral cutaneous nerve. Data related to the evaluation of its cutaneous sensibility are scarce, discrepant, and subject to methodological criticism.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the cutaneous sensibility of the IPAP flap 12 months after perineal reconstruction and compare it with the preoperative cutaneous sensibility of the gluteal fold (flap donor area).
  
  
  METHODS
  A prospective study of 25 patients undergoing abdominoperineal excision of rectum (APER) and reconstruction with bilateral VY advancement IPAP flap was conducted. The tactile, pain, thermal, and vibration sensibilities were analyzed in four areas of the gluteal fold preoperatively and in the four corresponding areas of the flap 12 months after surgery. Tactile sensibility was assessed using the Pressure Specified Sensory Device™ (PSSD™), which measures the pressure applied to the skin. The other types of sensibility were analyzed using a needle for pain, hot/cold contact for thermal, and a tuning fork for vibration sensibility.
  
  
  RESULTS
  A comparison between tactile sensibility thresholds on the gluteal fold preoperatively and on the flap 12 months after surgery showed no statistically significant difference, with p values>0.05 in all four areas evaluated. All patients had preserved pain, thermal, and vibration sensibility in all four areas, postoperatively.
  
  
  CONCLUSIONS
  In oncological perineal reconstructions after APER, it is expected that the cutaneous sensibility on the IPAP flap be maintained.
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: pscoltro@hotmail.com.
authors.forename: Pedro S
authors.initials: PS
authors.lastname: Coltro
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Ferreira
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Fábio F
authors.initials: FF
authors.lastname: Busnardo
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Marcelo V
authors.initials: MV
authors.lastname: Olivan
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Thiago
authors.initials: T
authors.lastname: Ueda
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Grillo
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Gastroenterology Surgery and Coloproctology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Marques
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Gastroenterology Surgery and Coloproctology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Caio S
authors.initials: CS
authors.lastname: Nahas
authors.affiliation: Institute of Cancer of the State of São Paulo, Division of Gastroenterology Surgery and Coloproctology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Sérgio C
authors.initials: SC
authors.lastname: Nahas
authors.affiliation: Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000601:surgery; D002081:Buttocks / Q000294:innervation*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D061525:Perforator Flap / Q000098:blood supply* / Q000294:innervation*; D010502:Perineum / Q000601:surgery*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012684:Sensory Thresholds; D014110:Touch
keywords: Anus neoplasms; Perforator flap; Perineum; Reconstruction; Rectal neoplasms; Sensory thresholds