Trunk, Pelvic & Perineal Reconstruction
Reconstructing complex defects where durable soft-tissue coverage, dead-space management and reliable healing are central to recovery.
Major cancer resections of the trunk, pelvis and perineum can leave large three-dimensional defects, exposed structures and areas at high risk of wound complications.
Reconstruction in these regions is designed around the geometry of the defect, the tissues that remain, previous or planned radiotherapy and the wider oncological treatment pathway.
The reconstruction is defined by the space that remains
These defects are often more than a missing patch of skin. Resection may leave a deep cavity, exposed vessels, bowel, bone or prosthetic material, or a separation between anatomical compartments that needs to be restored.
The reconstructive plan therefore considers both the visible wound and the three-dimensional space beneath it.
What may need to be reconstructed
Dead space
Large resections can leave cavities that are prone to fluid collection, infection and poor healing. Vascularised tissue can be used to fill this space and bring healthy tissue into the defect.
Soft-tissue cover
Exposed bone, vessels, prosthetic material or other structures may require durable, well-vascularised coverage to protect them and support healing.
Separation of spaces
Some defects require reconstruction of a barrier between the abdomen, pelvis, perineum or other anatomical compartments to restore structural integrity.
External contour
Where possible, reconstruction also considers the surface contour and the relationship between the reconstructed area and surrounding tissues.
Using vascularised tissue
Healthy, well-vascularised tissue is often central to reconstruction in previously irradiated, infected or heavily operated fields.
Depending on the defect, reconstruction may use local, regional or free tissue transfer. Muscle, myocutaneous or fasciocutaneous tissue can be selected according to the volume, reach, surface coverage and healing requirements of the defect.
Microsurgery becomes particularly useful when nearby tissues are unavailable, inadequate or have been compromised by previous surgery or radiotherapy.
Pelvic & perineal reconstruction
Pelvic and perineal cancer surgery can create anatomically complex wounds with substantial dead space and a high risk of wound-healing problems.
Reconstruction may be used to fill the pelvis, close the perineal defect and bring healthy tissue into a region affected by radiotherapy or extensive resection.
The choice of tissue depends on the size and orientation of the defect, previous abdominal operations, stomas, donor-site availability and the planned oncological procedure.
Trunk reconstruction
Defects of the abdominal wall, chest wall or posterior trunk may require soft-tissue coverage alone or reconstruction of deeper structural components as well.
Where the defect is extensive, the reconstructive plan needs to consider stability, protection of underlying structures, wound closure and the donor-site consequences of the chosen tissue.
Reconstruction in the setting of cancer treatment
Before resection
Early reconstructive discussion allows likely defects, previous scars, donor sites, stomas and radiotherapy effects to be incorporated into the operative plan before definitive surgery.
At the operation
The reconstruction is adapted to the final defect after resection. This often requires close intraoperative communication between the oncological and reconstructive teams.
Radiotherapy
Previous radiotherapy can significantly affect tissue quality and wound healing. Bringing in healthy vascularised tissue may be particularly valuable in these circumstances.
Recovery
Rehabilitation, mobility, stoma care and the need for subsequent oncological treatment all influence reconstructive planning and postoperative care.
Donor-site planning matters
Abdomen
Abdominal tissue can provide substantial volume and reach, but previous surgery, stomas and the need to preserve abdominal-wall function may limit its use.
Thigh
Thigh-based tissue can be useful for selected pelvic and perineal defects where local reach and adequate soft-tissue volume are required.
Gluteal region
Gluteal-based options may be valuable for posterior or perineal defects, depending on the resection, vascular anatomy and functional requirements.
Free tissue transfer
When regional options are not suitable, free tissue transfer allows tissue with the required characteristics to be brought from a more distant donor site.