Perineal Reconstruction with the Perineal Perforator Based Island Flap

Perineal area is composed of compact structures of urogenital organs and anus requiring a more sophisticated selection of flap and reconstruction. For achieving better outcome then conventional flap surgery, we use the perineal perforator based island flap for its reconstruction. After locating the perforator by Doppler, the flaps were designed according to the defect or expected vaginal orifice. The flaps were elevated bilaterally as island pattern. Finally defect or neovagina was reconstructed with inconspicious linear scar hidden in the inguinal crease. Five cases were performed with the perineal perforator based island flap. There were 3 cases of vulvar cancer, 1 case of transsexualism, and 1 case of ambiguous genitalia because of congenital adrenal hyperplasia. Operative results were satisfactory with good contouring and less prominent donor scar, when they were compared with other flap reconstructions such as latissimus dorsi perforator flap, groin flap, gracilis myocutaneous flap etc. The perineal perforator based island flap is highly recommended with the advantages of easy flap elevation, good rotation arc, and appropriate flap thickness for contouring. Compared with other conventional flaps, it can be selected as a good option for moderate defect of perineal area.

Parasacral Perforator - Based Island Flap for Pressure Sore

For treatment of the pressure sore, variable methods have been developed such as skin graft, local flap, myocutaneous or fasciocutaneous flap. The myocutaneous flap has been used commonly for the coverage and padding of the wound. However, sacrifice of the deep muscles causes some problems such as intraoperative bleeding, functional disabilities of donor sites, and difficulty in controling the volume of the flap for the skin reability of myocutaneous flaps. To overcome these disadvantages, we tried perforator-based myocutaeous island flaps for reconstruction of buttock area. During the dissection of the flap, we could control the volume and shape of the flap exactly depending on the perforator. And minimal morbidity of the donor site is expected because of significant volume of gluteus maximus muscle need not be sacrificed. The perforator-based flaps are especially indicated for ambulatory patients, and for paraplegic patients as well. Clinically, total of 20 cases were treated with 13 parasacral perforator-based myocutaneous island flaps and 7 parasacral perforator-based fasciocutaeous island flaps. The mean operating time was 84 minutes, and the mean flap size was 8x9.2 cm. In donor sites, primary closure were done in all cases, post operative complications were wound dishescence in 1 case, venous congestion in 3 cases, but immediately improved. Recurrence was not reported.