Experience with vaginal reconstruction utilizing the modified Singapore flap

Many types of vaginal reconstruction have been described, and we have employed several with varying degrees of success. All we have used seem to have drawbacks. In April 1989 Wee and Joseph from Singapore described a technique using neurovascular pudendal-thigh flaps as islands. Initially we used the procedure as described. Later we modified the approach by releasing the labia majora, allowing them to retract somewhat anteriorly, and rotating the flap into position. This procedure has been used in eight patients, in some instances under the most adverse circumstances in patients who have undergone multiple procedures and heavy irradiation (including intraoperative radiation) besides experiencing postoperative leakage of urine. Though we have had dehiscence and problems with infection and drainage in some of our patients, no flap has failed, contour is exceptionally good, and potential for function is satisfactory. The procedure requires less time and produces better results than any other technique employed by us in the more than 30 vaginal reconstructions we have carried out. The technique will be illustrated and clinical cases will be presented.