Modified KDPIF Technique in Vulvar Reconstruction: An Alternative Approach to the Conventional Technique with Reduced...

Currently, the reconstruction of vulvar defects presents a significant challenge for surgeons. The traditional keystone design perforator island flap (KDPIF) has emerged as a mainstream option owing to its reliable blood supply and procedural simplicity. However, postoperative complications such as flap scar contracture and urethral stricture remain prevalent. Therefore, this study introduces a Z-plasty-modified KDPIF technique designed to optimize flap tension distribution and reduce scar contracture while preserving the advantages of traditional KDPIF.

We conducted a retrospective study including 58 patients between 2016 and 2023. Of these, 28 received traditional KDPIF and 30 received modified KDPIF. Postoperative clinical outcomes were collected for all patients.

In this study, 30 patients underwent the modified KDPIF procedure, while 28 underwent the traditional KDPIF procedure. The average operation time for the modified KDPIF groups was 81.6 min with a flap size of 98.7 cm², whereas the average operation time for the traditional KDPIF groups was 85.8 min with a flap size of 102.7 cm². Considering postoperative complications, the traditional KDPIF groups experienced 14 complications, six of which were serious, whereas the modified KDPIF groups had eight complications, with one being serious. The study demonstrated that the modified group exhibited significantly lower POSAS scores during the postoperative period (P < 0.001).

This study establishes that the modified KDPIF technique is a safe and effective surgical approach. It preserves conventional KDPIF benefits while reducing the risk of functional impairments, such as postoperative urethral/vaginal stenosis, and alleviating postoperative scar complications.