Trunk and Perineal Reconstruction

​In plastic surgery, the area of your body from your shoulders to your hips, including your chest, abdomen, back, buttocks and groin is called your "trunk." Reconstruction of these areas refers to the repair and restoration of skin and soft tissue that has been weakened or removed by surgery for reasons such as cancer, infection, or trauma. This is important to ensure your internal organs are well protected and supported to prevent prolapse (herniation). Reconstruction aims to return the affected part of the trunk to as close to normal as is possible.

The Procedure

There are many techniques that can be used to reconstruct the trunk and perineum. These include:

• Primary closure – moving the sides of the defect together
• Free grafting – using skin or fascia from one part of the body to replace what is missing at the trunk and perineum
• Local flaps – movement of nearby tissues into the area that needs to be repaired
• Free flaps –  transfer of skin, soft tissue, muscle and/or bone to replace what is missing at the trunk and perineum. Because a large volume of tissue is moved from a faraway part of the body, the blood supply of the transferred unit (flap) has to be restored at the time of surgery by microscopic vascular repair.
• Artificial meshes – these are often used to reinforce tight repairs to reduce the risk of future hernia formation
  

After the Surgery

Dressings and/or bandages will be applied over the incisions. Small tubes (drains) will be placed to remove excess blood and fluid for at least several days. Painkillers and antibiotics will be prescribed to control the pain and minimize the risk of infection. A compression garment may have to be worn for several weeks to support the reconstruction.

You will have to remain in the hospital for some time to monitor your wound, graft and/or flap to ensure that it heals well. Throughout your recovery period, a physiotherapist will attend to you regularly for regular breathing exercises and to help you get used to walking again. It may take several months before you are able to return to normal activities.

Understanding the Risks

As with any major surgery, trunk and perineum reconstruction carries risks such as:

• Adverse reaction to the anaesthesia
• Bleeding
• Hematoma (accumulation of blood under the skin)
• Seroma (an accumulation of fluid under the skin)
• Damage to underlying important structures
• Failure of the reconstruction, for example due to graft or flap loss
• Wound infection
• Lung infection
• Poor wound healing or wound breakdown
• Poor scarring
• Blood clots

You may need to undergo revision surgery to correct these problems. The subject of risks, as well as potential complications of surgery are best discussed on a personal basis between you and your plastic surgeon.