Perineal and vaginal wall reconstruction using a combined inferior gluteal and pudendal artery perforator flap: a case report

Reliable perineal and posterior vaginal wall restoration following extensive abdominoperineal excision or pelvic exenteration is a reconstructive challenge, especially if the rectus abdominis is unavailable or insufficient for transpelvic transposition. In this short report, we present a novel combined perforator-based technique, in which an inferior gluteal perforator flap is used for perineal reconstruction whereas vaginal reconstruction is performed simultaneously by means of a pudendal artery perforator flap. This procedure circumvents functional muscle loss, permits a tension-free closure of difficult three-dimensional defects and offers a high degree of reconstructive flexibility, which allows a straightforward and independent reconstruction of two different anatomical units.