A Labia Majora Sharing Perforator Flap for Labial Defect Reconstruction

Area of Science:

• Plastic Surgery
• Gynecologic Oncology
• Reconstructive Surgery

Background:

• Reconstruction of labial defects requires consideration of aesthetic shape and urogenital function.
• Commonly used gracilis myocutaneous and gluteal fold flaps can be bulky, leading to urination stream deviation and deformity.
• Existing methods may not always provide optimal functional and aesthetic results for labial reconstruction.

Observation:

• A 76-year-old woman with squamous cell carcinoma of the labia majora underwent radical vulvectomy, resulting in an 8x6 cm defect.
• Primary closure posed risks of deformity and exposure of the urethral and vaginal vestibule.
• A dorsal clitoral artery perforator-based transposition sharing flap from the contralateral labia majora was utilized.

Findings:

• The contralateral labia majora sharing perforator flap successfully covered the defect without tension.
• Primary closure of the donor site was achieved.
• Postoperative follow-up at one year showed no deviation in the urination stream or significant asymmetry.

Implications:

• This perforator-based flap technique is feasible for reconstructing contralateral labia majora defects.
• The "like with like" reconstruction offers good functional outcomes and minimizes donor-site morbidity.
• This approach presents a valuable alternative for vulvar defect reconstruction, enhancing patient quality of life.