Perforator Versus Non-perforator Flap for Perineal Reconstruction: Long-Term Comparison of Complications and Quality of Life.

BACKGROUND

Perineal reconstruction remains challenging due to complex anatomy, high bacterial load, and frequent postoperative complications. Extensive tissue defects after oncologic resection or severe infection commonly necessitate reconstructive procedures. Although myocutaneous flaps are widely used, perforator flaps offer advantages such as muscle preservation and reduced donor-site morbidity. Given the perineal region's critical role in defecation, urination, and sexual function, evaluating patients' quality of life (QoL) after reconstructive surgery is essential.

METHODS

This single-center cohort study evaluated postoperative complication rates and QoL after perineal reconstruction with perforator versus non-perforator flaps from 2013 to 2023. All participants were invited to complete a postoperative QoL survey.

RESULTS

Of all the patients, 58 % received a perforator-based and 40 % a non-perforator-based reconstruction. One patient (2.3 %) underwent a combined approach. The primary indication for perineal reconstruction (68.9 %) was defect coverage after oncologic resection. Both groups had a 50 % complication rate. Donor-site morbidity was higher in the non-perforator flap group, with all complications classified as Clavien-Dindo grade III. Additional findings were exploratory: patient satisfaction was higher in the non-perforator flap group (100 % vs 66 %), although this group had a substantially longer follow-up period (4.14 vs 1.74 years). Conversely, numerically higher QoL scores were observed in the perforator flap group.

CONCLUSION

Perforator flaps demonstrated a more favorable donor-site profile, representing the most robust finding of this cohort. Observed differences in complications and patient-reported outcome measures are exploratory, and QoL continues to be insufficiently addressed in oncologic perineal reconstruction, underscoring the need for enhanced interdisciplinary collaboration.