Skip to main content

Advertisement

Log in

Vulvar reconstruction using a “V-Y” fascio-cutaneous gluteal flap: a valid reconstructive alternative in post-oncological loss of substance

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

We will present our experience in vulvar reconstruction using a local fascio-cutaneous flap, in order to get an easier intra-operative management and a good post-operative outcome.

Methods

Between May 2006 and December 2008, eight patients with vulvar carcinomas underwent a vulvar reconstruction, using a V-Y advancement flap of the gluteal fold. This fascio-cutaneous flap, based on the perforator vessels originated from the internal pudendal artery, was used for the reconstructive treatment of patients who had undergone a vulvectomy with medium-size defects.

Results

All the 16 flaps prepared survived without major complications. Walking and sitting positions were restored in few post-operative days. Length of hospitalisation was 2–3 weeks. The flaps restored sensitivity few months after surgery. In no case the surgical scars needed being revised.

Conclusions

The follow-up results proved satisfactory in terms of patients’ compliance and morphological results. The flap appeared to be thin, well vascularised and very flexible in its advancement. The post-operative follow-up is characterised by a rapid healing and a low incidence of short- and long-term complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hacker NF (2004) Vulvar cancer. In: Berek JS, Hacker NF (eds) Practical gynaecologic oncology, 4th edn. Williams & Wilkins, Philadelphia, pp 543–584

  2. Beller U, Maisonneuve P, Benedet JL, Heintz AP, Ngan HY, Pecorelli S, Odicino F, Creasman WT (2003) Carcinoma of the vulva. Int J Gynaecol Obstet 83(Suppl 1):7–26

    Article  PubMed  Google Scholar 

  3. Joura EA, Lösch A, Haider-Angeler MG, Breitenecker G, Leodolter S (2000) Trends in vulvar neoplasia. Increasing incidence of vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva in young women. J Reprod Med 45(8):613–615

    CAS  PubMed  Google Scholar 

  4. Lanneau GS, Argenta PA, Lanneau MS, Riffenburgh RH, Gold MA, McMeekin DS, Webster N, Judson PL (2009) Vulvar cancer in young women: demographic features and outcome evaluation. Am J Obstet Gynecol 200(6):645e1–645e5

    Google Scholar 

  5. Kumar S, Shah JP, Bryant CS, Imudia AN, Morris RT, Malone JM Jr (2009) A comparison of younger vs older women with vulvar cancer in the United States. Am J Obstet Gynecol 200(5):e52–e55

    Article  PubMed  Google Scholar 

  6. Finan MA, Barre G (2003) Bartholin’s gland carcinoma, malignant melanoma and other rare tumours of the vulva. Best Pract Res Clin Obstet Gynaecol 17(4):609–633

    Article  PubMed  Google Scholar 

  7. American Cancer Society (2009) Cancer reference information 2009. Available at http://www.cancer.gov. Accessed 1 May 2009

  8. De Hullu JA, Hollema H, Lolkema S, Boezen M, Boonstra H, Burger MP, Aalders JG, Mourits MJ, Van Der Zee AG (2002) Vulvar carcinoma. The price of less radical surgery. Cancer 95(11):2331–2338

    Article  PubMed  Google Scholar 

  9. Penson RT, Wenzel LB, Vergote I, Cella D (2006) Quality of life considerations in gynecologic cancer. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95(Suppl 1):S247–S257

    Article  PubMed  Google Scholar 

  10. Höckel M, Dornhöfer N (2008) Vulvovaginal reconstruction for neoplastic disease. Lancet Oncol 9(6):559–568

    Article  PubMed  Google Scholar 

  11. Weikel W, Schmidt M, Steiner E, Knapstein PG, Koelbl H (2008) Reconstructive plastic surgery in the treatment of vulvar carcinomas. Eur J Obstet Gynecol Reprod Biol 136(1):102–109

    Article  PubMed  Google Scholar 

  12. Salgarello M, Farallo E, Barone-Adesi L, Cervelli D, Scambia G, Salerno G, Margariti PA (2005) Flap algorithm in vulvar reconstruction after radical, extensive vulvectomy. Ann Plast Surg 54(2):184–190

    Article  CAS  PubMed  Google Scholar 

  13. Hatoko M (2006) Liposuctioned rectus abdominis myocutaneous flap to cover a vulval skin defect. Scand J Plast Reconstr Surg Hand Surg 40(1):60–63

    Article  PubMed  Google Scholar 

  14. Santanelli F, Paolini G, Renzi L, Persechino S (2007) Preliminary experience in reconstruction of the vulva using the pedicled vertical deep inferior epigastric perforator flap. Plast Reconstr Surg 120(1):182–186

    Article  CAS  PubMed  Google Scholar 

  15. Reddy VR, Stevenson TR, Whetzel TP (2006) 10-year experience with the gracilis myofasciocutaneous flap. Plast Reconstr Surg 117(2):635–639

    Article  CAS  PubMed  Google Scholar 

  16. Gorchev G, Tomov S, Baichev G, Popovska S, Velkova A (2006) Clinical and surgical aspects of vulvar reconstruction with tensor fasciae latae flaps after en bloc radical vulvectomy. J BUON 11(1):55–60

    CAS  PubMed  Google Scholar 

  17. Muneuchi G, Ohno M, Shiota A, Hata T, Igawa HH (2005) Deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction after radical vulvectomy: a less invasive and simple procedure utilizing an abdominal incision wound. Ann Plast Surg 55(4):427–429

    Article  CAS  PubMed  Google Scholar 

  18. Luo S, Raffoul W, Piaget F, Egloff DV (2000) Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction. Plast Reconstr Surg 105(1):171–173

    Article  CAS  PubMed  Google Scholar 

  19. Arvas M, Köse F, Gezer A, Demirkiran F, Tulunay G, Kösebay D (2005) Radical versus conservative surgery for vulvar carcinoma. Int J Gynaecol Obstet 88(2):127–133

    Article  CAS  PubMed  Google Scholar 

  20. Franchelli S, Leone MS, Bruzzone M, Muggianu M, Puppo A, Gustavino C, Di Capua E, Centurioni MG (2009) The gluteal fold fascio-cutaneous flap for reconstruction after radical excision of primary vulvar cancers. Gynecol Oncol 113(2):245–248

    Article  CAS  PubMed  Google Scholar 

  21. Moschella F, Cordova A (2000) Innervated island flaps in morphofunctional vulvar reconstruction. Plast Reconstr Surg 105(5):1649–1657

    Article  CAS  PubMed  Google Scholar 

  22. Sawada M, Kimata Y, Kasamatsu T, Yasumura T, Onda T, Yamada T, Tsunematsu R (2004) Versatile lotus petal flap for vulvoperineal reconstruction after gynecological ablative surgery. Gynecol Oncol 95(2):330–335

    Article  PubMed  Google Scholar 

  23. Pellegrino A, Fruscio R, Maneo A, Corso S, Battistello M, Chiappa V, Stomati M (2008) Harmonic scalpel versus conventional electrosurgery in the treatment of vulvar cancer. Int J Gynaecol Obstet 103(2):185–188

    Article  PubMed  Google Scholar 

  24. Ding Z, Wable M, Rane A (2005) J Obstet Gynaecol. Use of Ligasure bipolar diathermy system in vaginal hysterectomy 25(1):49–51

    CAS  Google Scholar 

  25. Hashimoto I, Nakanishi H, Nagae H, Harada H, Sedo H (2001) The gluteal-fold flap for vulvar and buttock reconstruction: anatomic study and adjustment of flap volume. Plast Reconstr Surg 108(7):1998–2005

    Article  CAS  PubMed  Google Scholar 

  26. Santanelli F, Paolini G, Renzi L, Persechino S (2007) Preliminary experience in reconstruction of the vulva using the pedicled vertical deep inferior epigastric perforator flap. Plast Reconstr Surg 120(1):182–186

    Article  CAS  PubMed  Google Scholar 

  27. Reddy VR, Stevenson TR, Whetzel TP (2006) 10-year experience with the gracilis myofasciocutaneous flap. Plast Reconstr Surg 117(2):635–639

    Article  CAS  PubMed  Google Scholar 

  28. Gorchev G, Tomov S, Baichev G, Popovska S, Velkova A (2006) Clinical and surgical aspects of vulvar reconstruction with tensor fasciae latae flaps after en bloc radical vulvectomy. J BUON 11(1):55–60

    CAS  PubMed  Google Scholar 

  29. Muneuchi G, Ohno M, Shiota A, Hata T, Igawa HH (2005) Deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction after radical vulvectomy: a less invasive and simple procedure utilizing an abdominal incision wound. Ann Plast Surg 55(4):427–429

    Article  CAS  PubMed  Google Scholar 

  30. Luo S, Raffoul W, Piaget F, Egloff DV (2000) Anterolateral thigh fasciocutaneous flap in the difficult perineogenital reconstruction. Plast Reconstr Surg 105(1):171–173

    Article  CAS  PubMed  Google Scholar 

  31. Lee PK, Choi MS, Ahn ST, Oh DY, Rhie JW, Han KT (2006) Gluteal fold V-Y advancement flap for vulvar and vaginal reconstruction: a new flap. Plast Reconstr Surg 118(2):401–406

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lara Lazzaro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lazzaro, L., Guarneri, G.F., Rampino Cordaro, E. et al. Vulvar reconstruction using a “V-Y” fascio-cutaneous gluteal flap: a valid reconstructive alternative in post-oncological loss of substance. Arch Gynecol Obstet 282, 521–527 (2010). https://doi.org/10.1007/s00404-010-1603-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-010-1603-1

Keywords

Navigation