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 tumour 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).

Indications

Some of the indications for perineal reconstruction may include anal, rectal, vulval and vaginal defects, perineal sarcoma (tumour), 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.

Post-operative care

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 lifting of heavy objects, exercising, and vaginal intercourse for at least 6 weeks following surgery, but not restrict yourself to complete bed rest.