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

Kim, Sang Wha; Lee, Won Moo; Kim, Jeong Tae; Kim, Youn Hwan

doi:10.1016/j.ygyno.2015.03.045

Cited by 16 publications

(12 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There have been numerous articles on the various methods of vulvar reconstruction using different types of flaps. 4,[6][7][8][9][10][11]13,[18][19][20][21][22] Several reports introduced their selection algorithm based on numerous reconstruction methods. 4,6 The surgical method of choice has mainly been described to be dependent on the size, shape, and location of the defect.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

2023

View full text Add to dashboard Cite

Objective Various surgeons adopt various vulvar reconstruction methods for different types of vulvar defects to restore anatomical structures. Vulvar reconstruction has relatively few references as it is performed in many different ways. Our report aimed to create a simplified reconstruction algorithm that can be used to select the reconstruction flap and to compare clinical outcomes. Methods The patients who underwent vulvar reconstruction between April 2017 and May 2020 were retrospectively reviewed. The reconstruction flap was selected according to a suggested algorithm, which accounted for the defect location depending on the vulvo-thigh junctional crease—the visual landmark of the inferior pubic ramus—and proper perforator location. Postoperative surgical complications, functional outcomes, and oncologic outcomes were analyzed according to the histologic and flap types. Results Forty-seven patients underwent reconstruction with 31 internal pudendal artery perforator flaps (66%) and 16 profunda artery perforator flaps or transverse upper gracilis flaps (34%). The histologic type included 21 extramammary Paget disease (44.7%), 20 squamous cell carcinoma (42.6%), and 6 other types (12.8%). Postoperative complications, including wound and functional complications, occurred in 10 patients (21.3%). There were more cases of wound complications with profunda artery perforator flaps and transverse upper gracilis flaps (37.5%) than those with internal pudendal artery perforator flaps (12.9%) (P = 0.04). There were 7 cases (14.9%) of 2-year oncologic recurrence with no significant differences in terms of histologic or flap types. Conclusions According to our suggested simplified algorithm, various types of flaps resulted in reliable surgical outcomes with minimal complication rates and acceptable functional and oncologic outcomes, and the primary goals of vulvar reconstruction were achieved effectively. Using our algorithm, selection of the reconstruction method could be simplified and specified despite the complexity of vulvar defects.

show abstract

Section: Discussionmentioning

confidence: 99%

“…There have been numerous articles on the various methods of vulvar reconstruction using different types of flaps 4,6–11,13,18–22 . Several reports introduced their selection algorithm based on numerous reconstruction methods 4,6 .…”

Section: Discussionmentioning

confidence: 99%

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

2023

View full text Add to dashboard Cite

show abstract

“…Muallem 2022 [24] 126 Flap combination (22), local fasciocutaneous flap (84), myocutaneous flap (20) Shin 2022 [51] Local perforator fasciocutaneous flap (27) Zhang 2022 [61] Local fasciocutaneous flap (30), VRAM (2) ALT (2) Aksan 2021 [25] Local fasciocutaneous flap (29), skin graft (1), VRAM (1) Giannini 2021 [26] Local fasciocutaneous flap (40) Tock 2019 [27] Gluteal thigh flap ( 16), local fasciocutaneous flap (45) Fin 2018 [28] Local fasciocutaneous flap (59) Hand 2018 [29] Local fasciocutaneous flap (42) Hellinga 2018 [9] Local fasciocutaneous flap (89) Confalonieri 2017 [10] 365 Local fasciocutaneous flap (365) Gentileschi 2017 [52] ALT (16) Lange 2017 [20] 114 Local fasciocutaneous flap (114) Chang 2016 [21] PAP ( 19) Conri 2016 [30] Local fasciocutaneous flap (36) Herraiz Roda 2016 [31] Local fasciocutaneous flap (17) Huang 2015 [53] Local perforator fasciocutaneous flap (16), PAP (11) Kim 2015 [32] Local fasciocutaneous flap (41) Negosanti 2015 [62] Local fasciocutaneous flap ( 28) DIEP (5) Nomura 2015 [33] Local fasciocutaneous flap ( 16), non-specified flap (3) Zhang 2015 [63] Gracilis myocutaneous flap (1), TRAM (1) ALT (24), DIEP (1) Zhang 2015_2 [64] Gracilis myocutaneous flap (2), TRAM (1) ALT ( 24), DIEP (6), pudendal thigh fasciocutaneous flap (7) Benedetti Panici 2014 [34] Local fasciocutaneous flap (29)…”

Section: Study # Flaps Non-perforator Perforatormentioning

confidence: 99%

Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction—A Systematic Review and Meta-Analysis

Wendelspiess,

Kouba,

Stoffel

et al. 2024

Cancers

View full text Add to dashboard Cite

Background: Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated. Methods: To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien–Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps. Results: Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator (n = 276) or a non-perforator flap (n = 1564) reconstruction (p* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients’ QoL was scarce. Conclusions: Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients.

show abstract

“…Reconstructive surgical procedures of the external female genitalia include many indications and treatment options, few of which are standardised. As regards the technique, there are several standardised flap-plasty techniques which can be used for vulva reconstruction, each of which has different advantages and disadvantages 10 , 11 , 12 , 13 , 14 , 15 , 16 . Inadequate transfer of tissue has a negative effect on vulva reconstruction, e.g., through the creation of excessive volume with unnatural projection, tissue rigidity, deformation, and functional limitations.…”

Section: Guidelinementioning

confidence: 99%

“…Rekonstruktive Operationen des äußeren weiblichen Genitale umfassen viele Indikationen und Therapieoptionen, deren Standardisierung noch wenig verbreitet ist. Technisch stehen diverse standardisierte Lappenplastiken zur Vulvarekonstruktion zur Verfügung, die jeweils Vor- und Nachteile aufweisen 10 , 11 , 12 , 13 , 14 , 15 , 16 . Ein inadäquater Gewebetransfer wird sich z.…”

Section: Leitlinieunclassified

Reconstructive and Aesthetic Surgeries on the Female Genitalia. Guideline of the DGGG, DGPRÄC, OEGGG and SGGG (S2k-Level, AWMF Registry No. 009/019, May 2022)

Beckmann

Borkenhagen

Fahlbusch

et al. 2023

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

Aim This official guideline was coordinated and published by the German Society for Gynaecology and Obstetrics (DGGG), the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), the Austrian Society for Gynaecology and Obstetrics (OEGGG), and the Swiss Society for Gynaecology and Obstetrics (SGGG). The guideline aims to provide a consensus-based overview of reconstructive and aesthetic surgeries on female genitalia based on an evaluation of the relevant literature. Methods This S2k-guideline was developed by representative members from different medical professions on behalf of the guidelines commission of the DGGG, DGPRÄC, OEGGG and SGGG using a structured consensus process. Recommendations Statements and recommendations on the epidemiology, aetiology, classification, symptoms, diagnosis, and treatment of acquired changes of the external genitalia are presented and special situations are discussed.

show abstract

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

Cited by 16 publications

References 28 publications

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

A Simplified Algorithmic Approach to Vulvar Reconstruction According to Various Types of Vulvar Defects

Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction—A Systematic Review and Meta-Analysis

Reconstructive and Aesthetic Surgeries on the Female Genitalia. Guideline of the DGGG, DGPRÄC, OEGGG and SGGG (S2k-Level, AWMF Registry No. 009/019, May 2022)

Contact Info

Product

Resources

About