Experience with gluteal V‐Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines

Abstract

Many post‐vulvectomy vulvar reconstruction solutions, using local fasciocutaneous flaps where possible, have been proposed. We report the use of V‐Y advancement flaps from the gluteal fold in medium to large vulvar reconstructions and a simple modification we made to the technique in order to minimise wound‐related complications. Between 2006 and 2016, 30 vulvar reconstructions were performed via a total of 59 flaps, 24 of which were raised using the proposed modification to the plasty design. Short‐ and long‐term (24 months) follow‐up data were analysed, postoperative flap sensitivity was tested, and any arising complications were recorded. The mean age of patients treated was 75.3 years (51‐92 years). The mean monolateral defect dimensions were 7.5 × 4.7 × 2.8 cm. Minor complications were recorded in 23% of patients (14% of flaps). One case of ostial stenosis occurred. Micturition and ambulation recovery was rapid, and flap sensitivity was fully restored 24 months after reconstruction. Scars were well hidden by natural soft tissue folds. The outcomes in this case series confirm that the gluteal V‐Y advancement fasciocutaneous flap is a useful and simple technique for reconstructing even large vulvar defects. It has a low functional and aesthetic impact and enables rapid return to autonomy. Moreover, the simple modification to the V‐Y flap proposed, designed to reduce tension at the apical part of the wound, appears to reduce the complication rate.

Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps

“…Bilateral flaps can be performed in cases where unilateral flap is insufficient or to provide symmetry. Oily and loose donor areas allow primary closure (2,14). Considering these advantages of local flaps in our cases, we preferred the use of local flaps primarily and often.…”

“…In our opinion, the exposure of the moist labium minor or vaginal mucosa after resections involving labium majus E a r l y A c c e s s and the suturing of this area with the skin tissue is another factor that makes wound healing difficult. Vaginal secretions slow down wound healing and increase the rate of infection by causing maceration in the suture line (2,19). Therefore, even if we use a vaginal tampon for 3 days after surgery, it is not possible to eliminate this effect.…”

“…Although older patients are the predominant population in cancer patients, there has been an increase in the diagnosis of HPV-associated in-situ carcinomas and different histological types in younger women. Other histological tumor types affecting the vulvar region are extra-mammary Paget's disease, melanoma, sarcoma, basal cell carcinoma, adenocarcinoma, and verrucous carcinoma (2). Ablative surgery of vulvar cancers often causes extensive soft tissue defects, and rapid postoperative recovery is required to allow adjuvant therapies (3)(4)(5)(6)(7).…”

Experience with Flaps After Resection of Vulvar Carcinoma: A Case Series

“…Vulvar carcinoma is a rare gynecologic cancer that affects approximately 5% of women. The most common histotype is squamous cell carcinoma, which is mainly caused by human papillomavirus in a majority of cases [8]. Other histological types of tumors involving the vulvar region include melanoma, basal cell carcinoma, sarcoma, adenocarcinoma, and verrucous carcinoma [9].…”

“…The cancer of the vulva is a rare type of cancer, which accounts for approximately 5% of all gynecological malignancies; squamous cell carcinomas make up 95% of all cancers [1]. Vulvar cancer has the following characteristics: strong invasion, rapid progression, and easy recurrence.…”