Seoul and Guri, Korea; and Singapore From the Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University; the Section of Plastic Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital; and the Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital.
Plast Reconstr Surg. 2014 May;133(5):683e-687e. doi: 10.1097/PRS.0000000000000146.
Perineal reconstruction is a challenging prospect. Conventional flap reconstruction often involves the sacrifice of a source artery and muscle, resulting in significant donor morbidity. Perforator flaps sought to overcome this but required tedious dissection. In this article, the authors introduce a new concept in perineal reconstruction using perforator-based island flaps.
The perineal perforator-based island flap is raised based on perforators that most commonly arise from the perineal artery. The flap is designed in the inguinal and gluteal folds in order to achieve aesthetic, tension-free primary closure of the donor site. Eleven patients underwent perineal reconstruction using this approach. Patients ranged in age from 8 to 75 years, with a female-to-male ratio of 10:1.
All 11 operations were performed by a single surgeon (S.Y.M.H.). There were no cases of flap loss or donor-site complications, as defined by wound infection, dehiscence, or keloid formation. All 11 patients reported excellent satisfaction with regard to donor-site aesthetics.
Perineal perforator-based island flaps represent one of the most successful outcomes of the perforator concept. There is no sacrifice of donor vessels or muscle and minimal donor morbidity. The flap is also easily harvested and allows for challenging free-form flap design because it is based on reliable perforators.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
会阴重建是一个具有挑战性的课题。传统的皮瓣重建往往涉及到供应动脉和肌肉的牺牲，导致供区严重的发病率。穿支皮瓣试图克服这一问题，但需要繁琐的解剖。本文作者介绍了一种使用基于穿支的岛状皮瓣进行会阴重建的新方法。
会阴基于穿支的岛状皮瓣是根据最常见发自会阴动脉的穿支提起的。皮瓣设计在腹股沟和臀褶处，以实现供区的美学、无张力一期缝合。11 例患者采用该方法行会阴重建。患者年龄 8 至 75 岁，男女比例为 10:1。
所有 11 例手术均由一名外科医生（S.Y.M.H.）完成。无皮瓣坏死或供区并发症，如伤口感染、裂开或瘢痕疙瘩形成。所有 11 例患者对供区美学均报告了极佳的满意度。
会阴基于穿支的岛状皮瓣是穿支概念最成功的结果之一。没有供区血管或肌肉的牺牲，供区发病率最小。该皮瓣也易于采集，并允许进行具有挑战性的自由形态皮瓣设计，因为它是基于可靠的穿支。
临床问题/证据水平：治疗，IV。
