Perineal reconstruction using a bilobed pudendal artery perforator flap.

BACKGROUND: To reconstruct the perineal region, including the urogenital and anal triangle that differ from each other in tissue characteristics and function, we applied pudendal artery perforator flaps with a bilobed flap design. This bilobed flap design could improve the arc of flap rotation and the mobility of the flap so it could cover wide and deep defects. Moreover, it could preserve the characteristics of each triangle.

METHODS: This study enrolled a total of 15 female patients who had undergone perineal reconstruction with pudendal artery perforator flaps. Seven of them had vulva cancer, seven others had extramammary Paget's disease and the remaining one patient had rectovaginal fistula. We examined the location and shape of the defects, flap designs and their clinical courses.

RESULTS: All flaps survived during the entire follow-up period. The flap sizes ranged from 3x4 to 13x12 cm, and the follow-up period was 4.6 months on average. Bilobed flaps were used in nine patients, and unilobed flaps were used in six patients. The reconstructed areas were in good functional and aesthetic conditions.

CONCLUSION: We used a bilobed pudendal artery perforator flap according to the location and shape of defect areas in the perineal region. As a result, we could preserve the functional, morphological and cosmetic characteristics of the defect areas.