advances in perineal reconstruction after abdominoperineal resection: a narrative review of techniques, algorithms, and future directions

Advances in rectal cancer treatment in the modern medical era have brought increased attention to wound complications, quality of life, and the recovery process. consequently, perineal wound complications have become a significant concern following abdominoperineal resection (apr) for rectal and anal malignancies, especially in cases involving irradiation or anatomically complex surgical fields. this narrative review aims to review treatment options and various reconstructive strategies to optimize wound healing and functional outcomes. these options include primary closure, rotational and transposition flaps, musculocutaneous and perforator flaps, mesh prostheses, and emerging tissue-engineered scaffolds. each method is critically evaluated with respect to indications, complication rates, and long-term outcomes, with comparative data guiding evidence-based selection.to provide a comprehensive overview and improve the practical application of this review, we propose several algorithms designed to facilitate individualized surgical planning by incorporating patient-specific factors, defect characteristics, and oncologic context. these approaches are discussed within the framework of enhanced recovery protocols, highlighting the importance of multidisciplinary collaboration in achieving optimal outcomes.