Vulvoperineal defects after demolitive surgery for preneoplastic or malignant vulvar lesions require a reconstruction to restore good sexual functions and to offer a satisfactory cosmetic result. Several techniques of reconstruction have been described in the past, leading to a more conservative and localized treatment. This study retrospectively reviewed patients with primary or recurrent vulvar malignancies that had undergone vulvoperineal reconstruction between 2010 and 2016 using the V-Y advancement flap and the 2 variant of the lotus petal flap (LPF) in terms of surgical outcome and postoperative complications. Two hundred eighty-four (284) women were reviewed, 234 of them having undergone V-Y flap and 128, the LPF. Overall, postoperative complications occurred in 21.5% of patients including 21% (27/128) of the V-Y group and in 13% (14/106) of the LPF group. The 2 techniques are valid and feasible for vulvar reconstruction in case of moderate defects. No statistically significant differences in terms of complications were observed between the 2 groups overall (P = 0.588), or by comparing the primary (P = 0.202) or the recurrent setting (P = 0.281). Lotus petal flap, particularly the tunneled variant, was superior to V-Y advancement flap in terms of functional and cosmetic results in patients undergoing resection for primary vulvar malignancies.

Tunneled lotus petal flap is safe, easy and fast to perform, has a low rate of complications, and good functional and cosmetic results. This technique represents an optimal solution for plastic reconstruction in case of primary or recurrent vulvar disease, or in case of introital stenosis after primary inadequate closure.

Introduction: Tumour of the vulva is an uncommon pathology that requires radical surgery with wide tumour excision associated with lymphadenectomy. The reconstruction after demolitive surgery is necessary, and the need of new flaps has led us to evaluate the feasibility and efficacy of the previously described lotus petal flap, a local subcutaneous pedicle rotation flap. However, the lotus petal flap has not yet come into wide use, moreover, in the literature there are still only few papers on this topic. Patients, Materials and Methods: From July 2007 to October 2010 we performed 69 modified lotus petal flaps in 41 patients at San Gerardo Hospital, Monza. 28 were bilateral flaps and 13 singular flaps. Results: We report very few complications: 1 case of partial skin flap necrosis, 1 case of total flap necrosis and 2 cases of donor site wound breakdown. Mean age was 72 years (range: 53?87 years) and mean surgery time was 1?h 25?min (range: 45?min?2?h 45?min). The mean length of follow-up was 15 months (range: 4?42 months). Functional and ?aesthetic results were considered optimal. Conclusions: We believe that this flap represents an optimal solution to perineal reconstruction after radical vulvectomy because it has a low rate of complications, it is safe, easy and fast to perform and it has a good functional and ?aesthetic result.

The authors describe a case of Noma or Cancrum Oris, an oral gangrenous disease, features more frequently found in children from developing countries. The clinical features, its ethiopathogenesis, and its particular link with different geographic and economic areas of the world, its clinical evolution as well as surgical treatment are all discussed. Underlined is the functional and organic aspect of this disease, in particular the distortion of the face, which commonly involves the full thickness of the cheek skin and bone, mandibular ankylosis and craniofacial dismorphisms, and the modern approach in reconstructive microsurgery. The authors report a case of a patient affected by Noma, with a very evident left face dismorphism, where we found a brilliant solution using a left radial forearm fasciocutaneous free flap, appropriately shaped.

Tunneled lotus petal flaps represents a feasible, attractive and versatile surgical reconstructive technique that can be easily performed after surgical treatment of vulvoperineal neoplasms.