Overcoming the Three-Dimensional Complexity of Vulvar Defects: A Stepwise, Multi-Flap Approach.

Area of Science:

• Reconstructive surgery
• Plastic surgery
• Gynecologic oncology

Background:

• Complex vulvar defects pose significant reconstructive challenges due to their intricate 3D nature.
• Reconstruction often requires specialized techniques to restore both form and function.

Purpose of the Study:

• To introduce and evaluate a combined flap surgical approach for extensive vulvar defects involving the vaginal wall, anal canal, and perineum.
• To assess the functional and aesthetic outcomes of this multi-flap technique.

Main Methods:

• A combined flap approach utilizing locoregional tissues was employed.
• Key flaps included the gluteal fold flap, mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap.
• Defect sizes ranged from 108 to 157 cm²; outcomes were assessed via questionnaire.

Main Results:

• The multi-flap technique successfully reconstructed large vulvar and perianal defects.
• Patient-reported outcomes regarding micturition, defecation, coital function, introitus opening, and aesthetics were favorable.
• High patient satisfaction was reported post-operatively.

Conclusions:

• A combined multi-flap approach is effective for managing complex vulvar and anal defects.
• This technique optimizes aesthetic and functional results, leading to improved patient satisfaction.
• Maximizing the use of locoregional tissues is crucial for successful reconstruction.