Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction

Sonda, Regina; Monticelli, Andrea; Venezia, Erica Dalla; Giraudo, Chiara; Giatsidis, Giorgio; Bassetto, Franco; Macchi, Verónica; Tiengo, Cesare

doi:10.1097/gox.0000000000003177

Cited by 4 publications

(10 citation statements)

References 60 publications

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“…The vulvo-thigh junctional crease is considered as the standard to make it visual inspection and monitoring easier in the operation room. 23 The defect was classified as the suggested algorithm involving the defect location inside of the vulvo-thigh junctional crease and proper perforator. Complete wound closure and functional maintenance with a low rate of postoperative complications was achieved in every patient despite the wide variety of surgical wound topographies.…”

Section: Discussionmentioning

confidence: 99%

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

2023

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Objective Various surgeons adopt various vulvar reconstruction methods for different types of vulvar defects to restore anatomical structures. Vulvar reconstruction has relatively few references as it is performed in many different ways. Our report aimed to create a simplified reconstruction algorithm that can be used to select the reconstruction flap and to compare clinical outcomes. Methods The patients who underwent vulvar reconstruction between April 2017 and May 2020 were retrospectively reviewed. The reconstruction flap was selected according to a suggested algorithm, which accounted for the defect location depending on the vulvo-thigh junctional crease—the visual landmark of the inferior pubic ramus—and proper perforator location. Postoperative surgical complications, functional outcomes, and oncologic outcomes were analyzed according to the histologic and flap types. Results Forty-seven patients underwent reconstruction with 31 internal pudendal artery perforator flaps (66%) and 16 profunda artery perforator flaps or transverse upper gracilis flaps (34%). The histologic type included 21 extramammary Paget disease (44.7%), 20 squamous cell carcinoma (42.6%), and 6 other types (12.8%). Postoperative complications, including wound and functional complications, occurred in 10 patients (21.3%). There were more cases of wound complications with profunda artery perforator flaps and transverse upper gracilis flaps (37.5%) than those with internal pudendal artery perforator flaps (12.9%) (P = 0.04). There were 7 cases (14.9%) of 2-year oncologic recurrence with no significant differences in terms of histologic or flap types. Conclusions According to our suggested simplified algorithm, various types of flaps resulted in reliable surgical outcomes with minimal complication rates and acceptable functional and oncologic outcomes, and the primary goals of vulvar reconstruction were achieved effectively. Using our algorithm, selection of the reconstruction method could be simplified and specified despite the complexity of vulvar defects.

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Section: Discussionmentioning

confidence: 99%

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

2023

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“…19,20 However, perforator vessels inside the ischiorectal fossa have not received much attention to date. 10…”

Section: Discussionmentioning

confidence: 99%

“…19,20 However, perforator vessels inside the ischiorectal fossa have not received much attention to date. 10 Various forms of perforator flaps can be elevated in the ischiorectal fossa. The most valuable advantage of these types of flaps is that the pedicle vessels are near the defect sites.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…8,9 However, details of the internal pudendal artery and skin perforators in the ischiorectal fossa are still obscure, as the fossa is a deep space between the perineal skin and the pelvic diaphragm that is filled with thick fatty tissue and likewise contains organs, such as the rectum, vagina, and urethra. 10 In this study, we used computed tomography angiography to safely elevate perforator flaps designed based on the ischiorectal fossa to comprehensively examine the branching patterns of the internal pudendal artery as well as those of the perforator arteries throughout the ischiorectal fossa in our presenting patients. Shinji Nagasaka, MD* Yoshiro Abe, MD, PhD* Yutaro Yamashita, MD, PhD* Hiroyuki Yamasaki, MD* Kazuhide Mineda, MD, PhD* Mitsuo Shimada, MD, PhD † Ichiro Hashimoto, MD, PhD* Background: Perforator flaps based on the ischiorectal fossa (IRF) (ie, internal pudendal artery perforator flaps) are useful for perineal reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic Study Evaluating Perforator Vessels in the Ischiorectal Fossa for Safe Elevation of Island Flaps

Nagasaka

Abe

Yamashita

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Perforator flaps based on the ischiorectal fossa (IRF) (ie, internal pudendal artery perforator flaps) are useful for perineal reconstruction. The three-dimensional characterization of perforator arteries in the IRF remains unclear, as the IRF contains thick adipose tissue as well as organs, such as the rectum, vagina, and urethra. This study aimed to evaluate perforators in the IRF to guide the safe elevation of skin flaps designed based on the IRF. Methods: IRF vessels were examined in 200 bilateral computed tomography angiography scans performed in 100 patients. We examined branching patterns arising from the internal iliac artery and the origins of the skin perforators in the IRF. Results: The branching patterns of the internal iliac artery were divided into three groups: perforators derived exclusively from the internal pudendal artery (78%), perforators derived from the internal pudendal artery and the inferior gluteal artery (18%), and perforators derived exclusively from the inferior gluteal artery (4%). The average number of perforators in the IRF was 1.5 ± 0.7. The number of perforators was significantly higher in women than in men. The perforator arteries were found exclusively around the medial and dorsal sides of the ischial tuberosity. Conclusions: We found that perforators in the IRF were stable. All cases had more than one skin perforator, which was mainly derived from the internal pudendal artery. Although perforators cannot be identified during flap elevation because the fatty tissue in the IRF is very thick, physicians must focus on preserving the perforator-containing fatty tissue around the ischial tuberosity.

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Genitocrural Island Perforator Flap (GIP-Flap): An ideal surgical technique for covering uni- or bilateral vulvar loss tissue

Hallonet,

Martinez,

Meresse

2024

Annales de Chirurgie Plastique Esthétique

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Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction

Cited by 4 publications

References 60 publications

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

Radiographic Study Evaluating Perforator Vessels in the Ischiorectal Fossa for Safe Elevation of Island Flaps

Genitocrural Island Perforator Flap (GIP-Flap): An ideal surgical technique for covering uni- or bilateral vulvar loss tissue

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