{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T04:15:10Z","timestamp":1787976910728,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,1,4]],"date-time":"2017-01-04T00:00:00Z","timestamp":1483488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Reconstruction of perineal defects remains a challenge because such defects can be extensive, complex, and three\u2010dimensional. This report presents a retrospective review of our past 5 years of experience in perineal reconstruction, and suggests a simple algorithmic approach according to anatomical divisions with multiple pedicled perforator flaps for extensive perineal defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2011 to December 2015, 16 patients, including 5 men and 11 women, underwent reconstruction of extensive perineal defects. The defect size varied from 11 \u00d7 10 cm<jats:sup>2<\/jats:sup> to 23 \u00d7 28 cm<jats:sup>2<\/jats:sup>. A total of 37 perforator flaps were used in 16 cases, which included Fournier's gangrene in 4 cases, extramammary Paget's disease in 4, and skin cancer in 8. The defects were categorized according to anatomical location, and were covered by multiple pedicled perforator flaps using the closest perforators based on the perforasome theory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All of the defects achieved tension\u2010free primary closure. An average of 2.31 flaps (range, 2\u20133 flaps) was used for each patient. All of the flaps survived without partial or total loss, though temporary flap congestion occurred in three patients and minor wound dehiscence occurred in one case. There were no donor\u2013site complications. During an average follow\u2010up of 11.06 months (range, 10\u201312 months), the reconstructed areas achieved good functional and aesthetic outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiple pedicled perforator flaps could supply sufficient dimension to cover extensive perineal defects and achieve tension\u2010free closure. In addition, our simple algorithmic approach according to anatomical divisions could be easily applied to extensive perineal defects. \u00a9 2017 Wiley Periodicals, Inc. Microsurgery 37:394\u2013401, 2017.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30152","type":"journal-article","created":{"date-parts":[[2017,1,4]],"date-time":"2017-01-04T14:12:36Z","timestamp":1483539156000},"page":"394-401","source":"Crossref","is-referenced-by-count":33,"title":["<scp>P<\/scp>erineal reconstruction with multiple perforator flaps based on anatomical divisions"],"prefix":"10.1002","volume":"37","author":[{"given":"Joon P.","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang G.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Konyang University Hospital University of Konyang College of Medicine, Myunggok Medical Research Center Daejeon 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