Triple flap technique for vulvar reconstruction

Area of Science:

• Surgical Oncology
• Reconstructive Surgery
• Plastic Surgery

Background:

• Perineal defects frequently arise from vulvar cancer treatment and abdominoperineal resection.
• Surgical excision of vulvar cancer often results in significant skin defects requiring reconstruction.
• Current reconstruction aims to resurface the perineum rather than add volume.

Purpose of the Study:

• To present a new surgical technique for covering extensive perineal skin defects.
• To evaluate the efficacy of a 3-flap advancement technique in vulvar cancer reconstruction.

Main Methods:

• The study involved 3 patients undergoing large excisions for vulvar cancer with lymph node dissection.
• Reconstruction utilized three advancement flaps: two V-Y flaps based on pudendal perforator arteries and one Y-V Mons pubis flap.
• Flaps were designed to cover postero-lateral and superior aspects of the perineal defect.

Main Results:

• The 3-flap technique successfully covered the perineal defects in all patients.
• One patient experienced non-union, which healed by secondary intention.
• Negative pressure wound therapy on sutures yielded excellent results in the other two cases.

Conclusions:

• The 3-flap technique is a simple, reliable method for perineal reconstruction.
• This technique offers minimal donor site morbidity and can be performed without repositioning the patient.
• It avoids the need for delicate perforator dissection, simplifying surgical management.