Gluteal Fold V-Y Advancement Flap for Vulvar and Vaginal Reconstruction: A New Flap

Abstract

This flap is thin, reliable, sensate, easy to perform, and has matched local skin quality and concealed donor-site scar on the gluteal fold. In addition, it can cover large vulvovaginal defects because it can be advanced farther as a result of the character of the gluteal fold area. In our experience, the gluteal fold fasciocutaneous V-Y advancement flap has proven very useful for vulvar reconstruction, especially at the point of donor-site scar, flap thickness, and degree of flap advancement.

Vulvar and vaginal reconstruction using the “angel wing” perforator-based island flap

“…However, the major vascular plexus is remote from the vulva and vagina, limiting advancement and increasing tension of the flaps, and a conspicuous scar is also typically left on the thigh [2]. On the other hand, the gluteal fold flap can be easily harvested in a pattern similar to thigh flaps, with a more concealed donor site scar at the gluteal fold [4]. However, this flap is quite bulky to resurface the inner lining of the vagina and requires secondary procedures such as debulking.…”

“…Although musculocutaneous flaps still have their place in vulvar reconstruction, these flaps are only useful for the largest defects such as extensive radical vulvectomy and/or exenteration-type surgery. With the search for thinner flaps and studies related to perineal blood supply, numerous fasciocutaneous flaps have since been introduced including medial thigh flaps [11,12], gluteal fold flaps [4,13], or superomedial thigh flaps [14,15], in V-Y advancement, rotational, or island pattern, respectively. Fasciocutaneous flaps from the thigh are thin, reliable, and quite easily elevated.…”

“…The main representative innovations can be condensed into V-Y advancement flaps and perforator-based flaps, which are based on the perforators of the perineal region [1][2][3][4].…”

Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps

“…Although the use of the gluteal region has been described previously for this role, this use has been limited to the musculocutaneous gluteal flap or as an advancement flap, which are each limited by the need to include muscle harvest or the advancement of irradiated tissue into the defect. [3][4][5] While popularized for use in breast reconstruction as free flaps, 15 pedicled gluteal artery perforator flaps have been described for local advancement into defects such as sacral pressure ulcer defects 16,17 and other lumbosacral defects. 6,7 Judge et al 9 described the gluteal artery perforator flap for this role, however, used these as advancement flaps, with irradiated tissue necessarily used in the flap, and contributing to complications such as wound dehiscence and infection.…”

“…[3][4][5] The gluteal artery perforator flap has been used locally for lumbosacral defects [6][7][8] and as a perforator-based advancement flap for perineal reconstruction, 9 however, these are associated with advancement of irradiated tissue into the defect and the associated complications. We present our technique of superior and inferior gluteal artery perforator (SGAP or IGAP) flaps for transposition to reconstruct such defects.…”