A Labia Majora Sharing Perforator Flap for Labial Defect Reconstruction

Reconstruction of a defect in the labial area has to be performed by taking account of the shape of the labial area and urogenital function. The gracilis myocutaneous flap and the gluteal fold flap are commonly used reconstructive procedures, but sometimes these flaps are too bulky and cause a deviation of the urination stream and/or deformity of the reconstructed site. In this report, we present our unique method of reconstruction using a contralateral labia majora sharing perforator flap. The patient was a 76-year-old woman who presented with squamous cell carcinoma on the left labia majora. Following radical vulvectomy with 2 cm radial margins and left inguinofemoral lymphadenectomy, an 8 × 6 cm² defect was created. Primary closure was possible, but there was a risk that it might cause an unfavorable deformity and exposure of the urethral and vaginal vestibule. Part of the contralateral side of the labia was used for a dorsal clitoral artery perforator-based transposition sharing flap. The defect was covered without tension, and the donor site was closed primarily. The postoperative course was good. One year after the operation, deviation of the urination stream and severe asymmetry was not observed. This study shows feasibility of perforator-based labia majora sharing flap for contralateral labia majora defect. Our "like with like" reconstruction provides a good functional outcome and less donor-site morbidity to the patient.