A New Flap for 3-Dimensional Vulvar and Vaginal Reconstruction: The

Kim, Sang Wha; Seo, Byung Chul; Oh, Deuk Young; Seo, Je Won; Ahn, Sang Tae; Rhie, Jong Won

Search: J Korean Soc Plast Reconstr Surg Search

CLOSE

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(6):847-849.
Published online November 1, 2010.

A New Flap for 3-Dimensional Vulvar and Vaginal Reconstruction: The "Butterfly Flap".

Sang Wha Kim, Byung Chul Seo, Deuk Young Oh, Je Won Seo, Sang Tae Ahn, Jong Won Rhie

Department of Plastic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. rhie@catholic.ac.kr

Abstract

PURPOSE
Traditional radical surgery for vulvar cancer produces severe skin and soft tissue defects in the vulvar and vaginal area. Vulvoperineal V-Y advancement fasciocutaneous flaps have limitations in advancement and tension at the wound margin and vaginal orifice area, causing wound disruption or vaginal wall exposure. Therefore, we designed the "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap for 3-dimensional reconstruction of vagina and vulvar area. METHODS: A 27 year-old female was diagnosed with vulvar intraepithelial neoplasia. Radical vulvectomy and full-thickness-skin-graft was performed. We designed a vulvo-perineal V-Y advancement fasciocutaneous flap as the greater wing and inguinal rotational skin as the lesser wing. After flap elevation, the inguinal flap was rotated 180degrees to reconstruct the labia major and vaginal orifice. The perineum was reconstructed using V-Y advancement flaps.
RESULTS
The flap survived completely, without any complications. After 6 months, the patient was able to perform normal sexual activities and after 18 months, the patient was able to give birth to normal child by caesarean section.
CONCLUSION
The traditional vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated and matches local skin quality. However, the vaginal wall becomes exposed due to limited advancement and tension of the flap. The "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap is useful for the release of vaginal orifice contracture, reconstruction of the labia major, and 3-dimensional reconstruction of vagina and vulvar area.

Keywords: Vulvar cancer; Flap; Reconstruction

TOOLS