Journal CME Article: Pelvic and Perineal Reconstruction-Article

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The document primarily discusses the management and reconstruction of pelvic and perineal defects. It begins with an anatomical description of the pelvic cavity, which is bounded by specific bones and contains organs such as the bladder and rectum, and highlights differences in male and female anatomy. The article further delves into the contemporary practices of reconstructive surgery for skeletal pelvic defects, focusing on two main procedures: external and internal hemipelvectomy. External hemipelvectomy, or hindquarter amputation, involves removing the lower extremity along with pelvic resection, typically performed if two of three crucial structures (femoral neurovascular bundle, sciatic nerve, hip joint) are resected. Internal hemipelvectomy aims to preserve the limb while removing tumors. The text outlines various classifications and techniques for these procedures, including the use of flaps for soft-tissue coverage and reconstruction strategies for bony stabilization.<br /><br />The article also discusses the reconstruction of soft tissue defects, especially in challenging anatomical areas like the perineum, which are complicated by fluid efflux, motion, and infection. Different reconstructive options, such as regional pedicled flaps and free flaps from other body parts, are highlighted, each with specific applications and limitations based on the defect size and location. Procedures like abdominoperineal resection, pelvic exenteration, vulvar, vaginal, scrotal, and penile reconstruction are detailed with their respective reconstructive algorithms.<br /><br />The document underscores the interdisciplinary nature of reconstructive efforts, the importance of maintaining or restoring pelvic stability, and the need for collaboration among surgical specialties for optimal patient outcomes. The research and techniques are grounded in extensive study and contributions from notable institutions, ensuring detailed and methodical approaches to improving reconstructive surgery practices.

Keywords

pelvic defects

perineal reconstruction

hemipelvectomy

soft-tissue coverage

bony stabilization

pedicled flaps

pelvic exenteration

interdisciplinary collaboration

reconstructive algorithms

surgical specialties