Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle

Area of Science:

• Reconstructive surgery
• Gynecologic surgery
• Plastic surgery

Background:

• Vaginal reconstruction is crucial for patients with congenital abnormalities or after cancer treatment.
• Existing methods often face challenges like limited tissue availability, donor site morbidity, and functional deficits.
• A reliable and functional method for neovagina creation is continuously sought.

Purpose of the Study:

• To describe and evaluate a new technique for vaginal reconstruction using bilateral perineal-thigh flaps.
• To assess the viability, functionality, and patient outcomes of this surgical approach.

Main Methods:

• A bilateral perineal-thigh flap with a subcutaneous pedicle was designed and raised.
• Flaps were tunneled into a created space between the urinary bladder and rectum for neovagina formation.
• Vascular supply was ensured via the perineal artery and anastomotic branches to the external pudendal artery.

Main Results:

• All four flaps in the study survived completely with no reported complications.
• Post-operative follow-up exceeding two years demonstrated that the reconstructed vaginas were expansible and showed minimal contraction.
• The neovaginal walls exhibited good sensitivity due to intact sensory nerve supply within the flaps.

Conclusions:

• Bilateral perineal-thigh flaps with a subcutaneous pedicle offer a viable and effective method for vaginal reconstruction.
• This technique provides a functional neovagina that is expansible, sensitive, and does not require a stent.
• The procedure demonstrates excellent flap survival and patient outcomes, making it a promising option for vaginal reconstruction.