Refined DIEP flap technique for vaginal reconstruction

Area of Science:

• Microsurgery
• Reconstructive surgery
• Gynecologic oncology

Background:

• Vaginal reconstruction is essential for patients with congenital absence or after oncologic surgery.
• Various flap techniques exist, but perforator flap utilization remains less common.
• The deep inferior epigastric perforator (DIEP) flap is a muscle-sparing option for reconstruction.

Purpose of the Study:

• To evaluate the efficacy and outcomes of vaginal reconstruction using the deep inferior epigastric perforator (DIEP) flap.
• To assess the feasibility of using pedicled DIEP flaps for neovagina creation.

Main Methods:

• Five patients with congenital vaginal absence and one with total vaginectomy underwent reconstruction with pedicled DIEP flaps.
• Preoperative enhanced computed tomography (CT) with 3D reconstruction guided perforator selection.
• Flaps were vertically oriented, tubed, and tunneled to create the neovagina.

Main Results:

• All deep inferior epigastric perforator (DIEP) flaps achieved complete survival.
• One patient experienced wound infection, managed with local care.
• Mean follow-up was 5 months, with stable vaginal depth and no orifice constriction.

Conclusions:

• The vertical deep inferior epigastric perforator (DIEP) flap is a dependable choice for total vaginal reconstruction.
• This technique yields consistent outcomes and spares the rectus abdominis muscle.
• The DIEP flap provides a viable alternative for neovagina creation.