Gluteal Fold Fasciocutaneous Turnover Flap for Reconstruction of Perineum and Vaginal Wall

Park, Choon Sung; Moon, Ji Hyun; Lee, Nae Ho; Yang, Kyung Moo

Abstract

Soft tissue reconstruction after tumor surgery in the area of the perineum and vagina presents a difficult challenge. The reconstructive surgeons solve this problem primarily using skin graft, local fasciocutaneous or musculocutaneous flaps, although free tissue transfer is also used. Closure of deep defects is preferably performed using a musculocutaneous flap, but in more superficial cases, use of a less bulky fasciocutaneous flap is used. The fasciocutaneous flap has been proven not necessarily to include the muscular layer for sufficient blood supply. Moreover, elevation of pure skin and fascia rather than that of musculocutaneous unit increases the flexibility individualizing the flap design. A 60-years-old female suffered from protrusion of anterior vaginal wall with a significant residual perineal defect and loss of the posterior vaginal wall after Mile's operation and radiation therapy. A new fasciocutaneous turnover flap as a modification of the gluteal fold fasciocutaneous flap was designed to solve the particular reconstructive problems. The flap is based on branches of the internal pudendal artery. In our case the flap survived without complications and donor scar was inconspicuously located in the gluteal fold. This new flap eventually enabled the successful reconstruction of the posterior vaginal wall and perineal soft tissue defect.