Reconstruction of the Intra-Abdominal Pelvis and the Perineum

Abstract

Reconstruction following excision of cancers involving the pelvis, perineum, or vagina is complex for many reasons. First, the perineum is the exit site for three separate epithelialized structures—the rectum and gastrointestinal tract, the urethra and urologic tract, and in women, the vagina and gynecologic tract. Second, the deep location of the pelvis is difficult to access, and the perineum and vaginal areas are relatively remote from common flap donor sites. Third, the unyielding nature of the bony pelvis acts to block wound contracture as a means of wound healing. And fourth, the pelvis, perineum, and vagina are associated with multiple sexual, reproductive, and body image issues of variable importance to each patient. This chapter will elucidate some of the reconstructive options unique to the intra-abdominal pelvis, the perineum, the vagina, and the buttocks.