Reconstruction of small and moderate defects of the perineum

Introduction: Resection of benign, premalignant or malignant lesions of the perineum result in tissue defects, which are preferably reconstructed with a flap rather than closed primarily or covered with a skin graft. Numerous skin flaps have been utilized with varying success rates. Patients and Methods: The charts of all female patients with perineal defects operated by the author during the past five years were retrospectively reviewed. Two flaps were used: a modified Limberg (rhomboid rotation) flap for small defects and a bilateral medial thigh V-Y advancement flap for moderate defects. Results: Seven patients were found. Two patients were operated because of benign pathology and five because of a pre- or malignant lesion. Two small and five moderate defects resulted after the resection. All flaps survived and there were no major complications. All patients had sensation on the flap postoperatively and were pleased with the functional and aesthetic result. Conclusion: Small perineal defects are satisfactorily restored with a rotation rhomboid flap, whereas moderate sized defects are best reconstructed with bilateral medial thigh V-Y flaps.