Pudendal Artery Flap (Singapore) for Perineal Reconstruction

Resection of the perineal area is challenging. Not only is there a component of loss of skin and muscle, but one must also consider reconstruction in an immediate or delayed fashion; whether a vaginal resection will result in partial or a total defect; and, if partial, whether the vaginal loss will be on the anterior, posterior, or distal vaginal wall. The pudendal flap may not be the best option for some of these defects. Loss of the vaginal introitus as well as part of the vault requires careful planning to provide a flap design with adequate length and width to prevent stenosis. Fraught with bacterial contamination, limitation of tissue advancement, and often tissues subjected to previous adjuvant therapy, perineal reconstruction is frequently accompanied by complications. Knowledge of the appropriate anatomy reduces morbidity. This chapter will focus on the pudendal (Singapore) artery flap for reconstruction. At the end of the chapter, readers should be able to understand the anatomy, design of the flap, and management of potential complications