What question did this study set out to answer?

This research aims to compare complication rates and quality of life after perineal reconstruction using perforator versus non-perforator flaps.

June 8, 2026Annals of Surgical Oncology0 citationsOpen Access

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

SWSéverin WendelspiessUniversity of Basel JSJosefin T. SandstedtUniversity of Bern JSJulia StoffelUniversity of Basel

Key Points

This research aims to compare complication rates and quality of life after perineal reconstruction using perforator versus non-perforator flaps.
Single-center cohort study conducted from 2013 to 2023
Postoperative quality of life surveys were completed by all participants
Complications were classified using the Clavien-Dindo grading system.
Both groups exhibited a 50% complication rate, all classified as Clavien-Dindo grade III.
Donor-site morbidity was higher in the non-perforator flap group.
Patient satisfaction was higher in the non-perforator flap group (100% vs 66%), although this group had longer follow-up (4.14 vs 1.74 years).

Abstract

Abstract 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.

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