Arch Plast Surg.  2014 Jul;41(4):379-386. 10.5999/aps.2014.41.4.379.

Subunit Principle of Vulvar Reconstruction: Algorithm and Outcomes

• Tan BK
• Kang GC
• Tay EH
• Por YC

• KMID: 2267685
• DOI: http://doi.org/10.5999/aps.2014.41.4.379

Abstract

BACKGROUND
Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction.
METHODS
From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps.
RESULTS
The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis.
CONCLUSIONS
We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.

Keyword

Vulvar; Carcinoma; Surgical flaps

MeSH Terms

Cicatrix
Coitus
Comorbidity
Defecation
Female
Humans
Paget Disease, Extramammary
Skin Transplantation
Surgical Flaps
Tissue Donors
Urethral Stricture
Urination
Vulva
Wounds and Injuries