<scp>P</scp>erineal reconstruction with multiple perforator flaps based on anatomical divisions

Hong, Joon Pio; Kim, Chang G.; Suh, Hyun Suk; Kim, Hoon; Yoon, Chi Sun; Kim, Kyu N.

doi:10.1002/micr.30152

Cited by 30 publications

(24 citation statements)

References 27 publications

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“…In 1993, they described the application of anterolateral thigh perforator flap (13). The application of perforator flap in the perineum was explored and widely used since then (14)(15)(16)(17)(18). The blood supply of perforator flap comes from small and perforating branch vessels which go through the deep fascia.…”

Section: Discussionmentioning

confidence: 99%

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Dai

et al. 2020

Scand J Surg

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Background and Aims: The unique anatomical and physiological function of the perineum region makes it difficult to be repaired after tumor resection. We aim to evaluate the efficacy of PSC divisional reconstruction strategy in the reconstruction of perineal skin defect. Materials and Methods: This study includes patients undergoing perineal skin defect reconstruction with PSC strategy—P (penis), S (scrotum), C (circum-penoscrotal skin) divisional reconstruction strategy. Results: From August 2013 to August 2018, 47 patients were enrolled in the surgical procedure. The defect area after resection measured 2 cm × 2.5 cm, minimum, and 12 cm × 18 cm, maximum. Among them, the cases involved one, two, and three zones are 12, 10, and 25, respectively. The skin defects were divisionally repaired. All flaps were well survived without complications or scar contracture. No tumor recurrence happened. Conclusion: The application of PSC divisional reconstruction strategy is a promising way to repair wounds in circum-penoscrotal skin area. Moreover, this strategy is easy to process and shows no significant complications during follow-up period.

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Section: Discussionmentioning

confidence: 99%

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Dai

et al. 2020

Scand J Surg

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“…The medial circumflex femoral artery flap (Coskunfirat et al, ; Hallock, ; Karsidag, Akcal, Sirvan, Guney, & Ugurlu, ), profunda femoris artery perforator flap (Scaglioni, Chen, & Yang, ), and combined multiple perforator flaps (Hong et al, ) have also been used for the reconstruction of the perineal area. Although the perforator location is closer than the lateral thigh flap, it is difficult for inexperienced surgeons to perform as there are numerous variations in the perforator location.…”

Section: Discussionmentioning

confidence: 99%

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

2019

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Background Successful penoscrotal reconstruction requires proper resurfacing of the defect and maintenance of the original shape of the penis and scrotum. We examined the feasibility of using the superficial circumflex iliac artery perforator (SCIP) propeller flap to effectively reconstruct penoscrotal defects. Methods Eleven male patients with an average age of 62.2 years were retrospectively evaluated. The average defect size was 21.3 × 10.5 cm2 (range: 10 × 8–24 × 16 cm2). An eccentrically located elliptical flap was constructed using a handheld Doppler device after detecting the perforator as the pivot point. The medial branch of the superficial circumflex iliac artery was used for all cases. Flaps were designed to cover 70–80% of the defect area and the average rotation arc was 165°. Results The average flap dimension was 19.7 × 7.7 cm2. Two cases showed partial necrosis in the flap tip area. There were no instances of total flap loss or lymphorrhea, or complications such as scar contracture, urination problems, erectile dysfunction, or discomfort during intercourse. Conclusions The SCIP flap is an effective and ideal method for penoscrotal reconstruction considering the loose, elastic, and thin nature of the tissue. Elevation is easily facilitated, and the thickness of the SCIP flap can be adjusted without microsurgery.

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“…The perineum, especially, is considered a “perforator‐rich” area, and perforator flaps are now the mainstay of perineal wound reconstruction (Kim, Ho, Hwang, & Lee, ). Perforators located close to the perineoscrotal region, including the internal pudendal, medial circumflex femoral, and superficial inferior epigastric artery perforators, are commonly used in perineal reconstructions (Hashimoto, Abe, & Nakanishi, ; Hong et al, ). Hong et al () reconstructed 37 perineoscrotal defects using flaps based on the abovementioned perforators and reported flap survival in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Perforators located close to the perineoscrotal region, including the internal pudendal, medial circumflex femoral, and superficial inferior epigastric artery perforators, are commonly used in perineal reconstructions (Hashimoto, Abe, & Nakanishi, ; Hong et al, ). Hong et al () reconstructed 37 perineoscrotal defects using flaps based on the abovementioned perforators and reported flap survival in all patients. In patients in whom these perforators are intact, flaps based on them are undoubtedly the best choice for reconstructing perineoscrotal defects.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report

et al. 2019

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Fournier's gangrene is lethal necrotizing fasciitis that involves the perineum and external genitalia. We describe the case of a 52-year-old man with Fournier's gangrene who underwent reconstruction of an extensive perineoscrotal defect using three pedicled perforator flaps. Three debridement procedures resulted in a skin and soft tissue defect of 36 × 18 cm involving the perineum, scrotum, groin, medial thigh, buttocks, and circumferential perianal area and left the perforating arteries originating from these locations unavailable for reconstruction. We repaired the defect using left deep inferior epigastric artery perforator (DIEP) (29 × 8 cm) and bilateral anterolateral thigh perforator (ALT) flaps (35 × 8 cm and 22 × 7 cm). The flaps reached the defect without tension, and the defect was successfully covered without a skin graft. No postoperative complications occurred except for epidermal necrosis involving a tiny part of the DIEP flap tip. Nine months postoperatively, the patient experienced no impairment of bowel function or hip joint movement. There was also no avulsion or ulceration of the reconstructed perineal skin, and the cosmetic appearances of the healed wound and donor site were satisfactory. The combination of these three perforator flaps enabled us to achieve a satisfactory outcome while avoiding skin grafts.

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Perineal reconstruction with multiple perforator flaps based on anatomical divisions

Cited by 30 publications

References 27 publications

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report

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