Reconstruction of soft tissue defect after 4th degree obstetric perineal laceration using perforator based bilateral V-Y advancement: A case report and review of the literature

Abstract

Obstetric anal sphincter injuries occur after urgent and difficult delivery. It may vary in extent and severity, ranging from minor mucosal tears of vagina to full-thickness lacerations that compromise the integrity and function of the anal sphincter complex. The anal sphincter is affected in third and fourth degree lacerations, and results anal incontinence, social, psychological and sexual problems, decreased quality of life, and financial costs. A 23-year-old female patient presented with a 5x5 cm perineal soft tissue defect extending from the posterior vaginal wall to the perianal skin following fourth-degree perineal laceration. The soft tissue defect was reconstructed with bilateral gluteal perforator-based V-Y advancement flaps. Aesthetically and functionally satisfactory results were obtained. Perineal reconstruction requires a multifaceted and algorithmic surgical approach based on the characteristics of the defect and the reconstructive needs. The perforator-based V-Y advancement flaps are an alternative reconstruction option for obstetric perineal defects, offering simplicity and effectiveness in preserving anatomical and physiological function.