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Perineal and Lower Extremity Reconstruction

Hollenbeck, Scott T. M.D.; Toranto, Jason D. M.D.; Taylor, Bruce J. M.D.; Ho, Trung Q. M.D.; Zenn, Michael R. M.D.; Erdmann, Detlev M.D., Ph.D., M.H.Sc.; Levin, L. Scott M.D.

Plastic and Reconstructive Surgery: November 2011 - Volume 128 - Issue 5 - p 551e–563e
doi: 10.1097/PRS.0b013e31822b6b87
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Learning Objectives: After reading this article, the participant should be able to: 1. Perform a preoperative assessment of patients undergoing perineal and lower extremity reconstruction. 2. Describe the various tissue flaps used to perform these reconstructions and the advantages and disadvantages of each. 3. Provide appropriate postoperative care and interventions to maximize outcomes.

Background: The lower extremity and perineum provide the foundation for upright posture and ambulation. These areas are made up of intricate contours with variable skin types and must withstand the functional demands of organ orifice support and weight-bearing forces. Successful reconstruction calls for careful preoperative planning and consideration of the site-specific demands.

Methods: The authors reviewed literature regarding the most current treatment strategies for lower extremity and perineal reconstruction.

Results: Perineal reconstruction is typically related to genitourinary or digestive tract abnormalities, mainly malignancies. Local and regional flaps are the mainstay of therapy, depending on their availability and the need for adjuvant therapy. Postoperatively, pressure reduction and closed-suction drainage are of major consideration. The lower extremities are prone to trauma, and these wounds often involve underlying and exposed bony abnormalities, and this must be considered in operative planning. Significant defects may be reconstructed with local or regional flaps and free-tissue transfer. The location of the wound and extent of surrounding tissue compromise are of major concern when determining flap coverage. Postoperatively, transition to ambulation and weight-bearing status is paramount.

Conclusions: Reconstruction of the lower extremity and perineum requires recognition of the high functional demands of these areas. Local and regional flaps and free tissue transfer allow reconstruction of complex wounds in these areas. Selecting the correct flap and navigating the postoperative recovery to arrive at functional restoration remain a significant challenge.


Philadelphia, Pa.; and Durham, N.C.

From the Department of Orthopedic Surgery, University of Pennsylvania, and the Division of Plastic, Reconstructive, Oral, and Maxillofacial Surgery, Duke University Medical Center.

Received for publication November 25, 2010; accepted February 16, 2011.

Disclosure:The authors have no financial disclosures or conflicts of interest to report.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations printed in the article.

L. Scott Levin, M.D.; Hospital of the University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2011American Society of Plastic Surgeons