Postburn Perineal Obliteration: Elimination of Perineal, Inguinal, and Perianal Contractures With the Groin Flap

Abstract

Deep burns of the perineum result in perineal obliteration, hip adduction contracture, and limitation of hip range of motion. Bodily hygiene becomes difficult to maintain. Perineal obliteration is often combined with inguinal and perianal contractures and genitalia injury. These factors present a challenge for the surgeon. The extreme scar surface deficit and the fold absence in the perineal region do not allow contracture elimination with local tissues. As skin grafts shrink, success can be achieved only by using pedicled or free flaps. The groin flap is an excellent tissue for simultaneous perineal, inguinal, and anal reconstruction. In cases involving both perineal and inguinal contractures, two groin flaps can be used simultaneously. The groin flap has steady axis blood circulation that prevents postoperative complications. The donor wound is primarily closed or partially covered with superficial inferior epigastric artery flap (bilobed flap). Corrective procedure is required for "dog-ear" elimination. In children, the flap continues to grow, thus preventing contracture recurrence. Good results have been achieved in four operated patients. This allows one to make the following conclusion: In cases in which the abdominal wall is healthy or not severely injured by scars, groin flap plasty can be considered as a preferable technique for obliterated perineum and multiple perineo-inguino-anal reconstruction in burned adult and pediatric patients.