Vulvar Reconstruction Using Keystone Flaps Based on the Perforators of Three Arteries

Area of Science:

• Surgical Oncology
• Reconstructive Surgery
• Gynecologic Oncology

Background:

• Vulvar reconstruction after malignancy resection often utilizes local flaps.
• Standard keystone flaps rely on random vascular perforators.
• A need exists for enhanced local flap designs in vulvar defect repair.

Purpose of the Study:

• To describe a novel keystone flap design for vulvar reconstruction.
• To evaluate the efficacy of this modified keystone flap in patients with vulvar defects.

Main Methods:

• The study details a keystone flap incorporating perforators from three specific arteries and the pudendal nerve.
• Four patients with vulvar malignancies underwent radical vulvectomy and reconstruction with these modified keystone flaps.
• Different keystone flap designs (standard, double opposing, omega variant, rotational) were employed based on defect morphology.

Main Results:

• All four patients demonstrated successful reconstruction with the modified keystone flaps.
• Patients experienced good functional recovery and preserved sensation.
• Acceptable cosmetic results were achieved post-reconstruction.

Conclusions:

• The modified keystone flap, incorporating named arterial perforators and the pudendal nerve, is a viable option for vulvar reconstruction.
• This technique offers good functional and aesthetic outcomes in patients undergoing vulvectomy for malignancy.