Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps

Labia minora reduction (labioplasty, labiaplasty) is the most common female genital aesthetic procedure. The majority of labia reductions are performed by trimming the labial edges. Many of these women present with (1) asymmetry; (2) scalloping of the labial edges with wide, occasionally painful scars; and (3) abrupt termination and distortion of the clitoral hood at its normal junctions with the clitoral frenula and the upper labium. Reconstruction can usually be performed with wedge excisions, labial YV advancement, and touch-up trimming. Reconstruction of a labial amputation, however, required the development of a new clitoral hood flap.

Twenty-four clitoral hood flaps were performed on 17 patients from June of 2006 through May of 2010. An island clitoral hood flap randomly based on the dartos fascia of the lower clitoral hood and medial labium majus is transposed to the ipsilateral labial defect to reconstruct a labium. Of the 10 patients with unilateral flaps, nine of the patients had previous bilateral labial reductions. Reconstruction of the opposite side in these nine women was performed using one or a combination of the following: wedge excisions, YV advancement flaps, or controlled touch-up trimming.

All 24 flaps survived, with four minor complications. Five patients underwent revision of a total of seven flaps, but only two were for complications. As experience increased, revisions for aesthetic improvement became less common.

Reconstruction of labia minora defects secondary to trimming labia reductions is very successful using a combination of clitoral hood flaps, wedge excisions, and YV advancements.