Flap reconstruction of the stenotic vagina

Reconstruction of the congenital or acquired stenotic vagina has traditionally been accomplished by skin grafting or reverse perineorrhaphy in addition to other less successful methods. The advent of musculocutaneous flaps has provided an excellent means of reconstructing the vagina after exenterative surgical treatment; however, the bulk associated with these flaps has precluded their use in reconstruction of the stenotic vagina. Thin, supple, axial pattern fasciocutaneous flaps based on the terminal branches of the internal pudendal artery provide a reliable and durable vaginal lining after surgical enlargement. Seven flaps have been used in four patients without complications. A follow-up period of greater than three years has yielded excellent results.