To observe the application effect of bilateral internal pudendal artery perforator flaps in the repair of perianal skin and soft tissue defects.

From July 2022 to December 2024， 26 patients with perianal skin and soft tissue defects were treated with bilateral internal pudendal artery perforator flaps at the Department of Repair and Reconstruction Surgery， Shougang Hospital， Peking University， including 17 males and 9 females， aged 40–62（49.5） years. There were 20 cases of colorectal malignant tumors and 6 cases of perianal malignant tumors. The area of perianal skin and soft tissue defects ranged from 22 cm×7 cm to 32 cm×14 cm. Postoperatively， the survival of the flaps， the healing of the donor and recipient sites， and the presence of complications were observed. Follow-up observations were made on the movement of the buttocks and the scar conditions.

A total of 52 internal pudendal artery perforator flaps were used in the 26 patients， all of which survived postoperatively. The flap area ranged from 14 cm×5 cm to 19 cm×7 cm. The follow-up period was 2–16（6.4） months. One patient developed fluid accumulation under the flap with partial necrosis at the tip， which improved after dressing changes. Five flaps exhibited delayed healing， and four flaps developed incision dehiscence due to early ambulation， all of which improved after dressing changes. Twenty-five patients had natural gluteal folds， while one patient had significant scarring at the sacrococcygeal junction， which mildly affected hip movement. All 26 patients were satisfied with the surgical outcomes.

The use of bilateral internal pudendal artery perforator flaps for repairing perianal skin and soft tissue defects provides reliable blood supply. It effectively closes wounds while reconstructing the gluteal fold， achieving good symmetry and aesthetic appearance with minimal traction on adjacent urogenital structures. This method is worthy of clinical promotion and application.