title: Perineal reconstruction with multiple perforator flaps based on anatomical divisions.
abstract: OBJECTIVE
  Reconstruction of perineal defects remains a challenge because such defects can be extensive, complex, and three-dimensional. This report presents a retrospective review of our past 5 years of experience in perineal reconstruction, and suggests a simple algorithmic approach according to anatomical divisions with multiple pedicled perforator flaps for extensive perineal defects.
  
  
  METHODS
  From January 2011 to December 2015, 16 patients, including 5 men and 11 women, underwent reconstruction of extensive perineal defects. The defect size varied from 11 × 10 cm2to 23 × 28 cm2. A total of 37 perforator flaps were used in 16 cases, which included Fournier's gangrene in 4 cases, extramammary Paget's disease in 4, and skin cancer in 8. The defects were categorized according to anatomical location, and were covered by multiple pedicled perforator flaps using the closest perforators based on the perforasome theory.
  
  
  RESULTS
  All of the defects achieved tension-free primary closure. An average of 2.31 flaps (range, 2-3 flaps) was used for each patient. All of the flaps survived without partial or total loss, though temporary flap congestion occurred in three patients and minor wound dehiscence occurred in one case. There were no donor-site complications. During an average follow-up of 11.06 months (range, 10-12 months), the reconstructed areas achieved good functional and aesthetic outcomes.
  
  
  CONCLUSIONS
  Multiple pedicled perforator flaps could supply sufficient dimension to cover extensive perineal defects and achieve tension-free closure. In addition, our simple algorithmic approach according to anatomical divisions could be easily applied to extensive perineal defects. © 2017 Wiley Periodicals, Inc. Microsurgery 37:394-401, 2017.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon P
authors.initials: JP
authors.lastname: Hong
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea.
authors.forename: Chang G
authors.initials: CG
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Suh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Chi S
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon, Korea.
authors.forename: Kyu N
authors.initials: KN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000601:surgery*; D010502:Perineum / Q000033:anatomy & histology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies