Pelvic and Perineal Reconstruction
Pelvic and perineal reconstruction procedures are performed to restore the normal structure and function of the urinary and genital organs (pelvic), and the surrounding area (perineal) that may be diseased due to infection, birth deformities, trauma or cancer.
Excision of tumor from the lower pelvis often results in large open wounds or the loss of a large area of tissue in the perineal area. Pelvic and perineal reconstructive surgeries are often indicated when the tissue defects are large and primary closure is impossible. A reconstructive surgery of the pelvis may include forming new genitals, bladder, or pelvic floor (muscles and tissues that support the pelvis).
Some of the indications for perineal reconstruction may include anal, rectal, vulval and vaginal defects, perineal sarcoma (tumor), and perineal squamous cell carcinoma.
Pelvic and perineal reconstruction
The complexity in anatomy, microbial environment and number of different organs of the pelvic and perineal region makes the procedure challenging. Pelvic and perineal reconstruction surgery uses tissue removed from a healthy region of the body (donor site) and implants it at the affected site. As the perineal area is particularly prone to problems with wound healing and infection, it requires a skilled plastic surgeon to perform the reconstructive surgery by importing fresh tissue (flaps), with a good blood supply, which has not been exposed to radiation. The consideration of flaps may depend on the patient’s condition and surgeon’s evaluation. Flaps may be obtained locally or from other locations of the body such as the abdomen, groin and thighs.
Pelvic and perineal wounds are generally slow to heal. Following the reconstructive surgery, you will be given detailed instructions on wound care by your doctor. You will have a catheter placed inside your body for a few days, to facilitate urination. You will be provided with stool softeners during the immediate postoperative period to prevent constipation and avoid straining with bowel movements. It is important to refrain from strenuous activities such as heavy lifting, exercising, and vaginal intercourse for at least 6 weeks following surgery, but not restrict yourself to complete bed rest.
Risks and Complications
The decision for any reconstructive surgery should be made with consideration of the risk factors for a poor outcome. Some of the factors that can put you at a greater risk include damaged skin from radiotherapy, pre-existing heart or lung disease, diabetes, obesity and smoking.
Some of the possible complications include:
- Ischemia (restricted blood supply to the tissue)
- Delayed healing
- Partial or complete loss of flap
- Loss of sensation at the donor or site of surgery
- Excessive bleeding or hematoma (pooling of blood under the skin) formation
- Bruising and problems in wound healing
- Anesthesia problems