Reconstruction of the labia majora using a neurovascular pedicled pudendal thigh flap after extensive vulvectomy for primary extramammary Paget's disease: A case report

Key Clinical MessageA neurovascular pedicled pudendal thigh flap was used to reconstruct labial defect after extensive vulvectomy for primary extramammary Paget's disease. The flap was reliable for the superior skin and ideal for large labial defect reconstruction. Extramammary Paget's disease (EMPD), a rare type of intraepidermal carcinoma, predominantly affects the genitalia. Generally, the treatment for primary EMPD is wide surgical excision; however, large tissue defects after resection necessitate customized reconstruction. Previously, several reconstruction techniques have been outlined, such as local skin flaps (V-Y flaps), skin grafts, pedicled flaps, and free flaps. However, the complexity of EMPD management is due to the multiple flaps and techniques. In this case report, we applied a neurovascular pedicled pudendal thigh flap to reconstruct a labial defect in a 68-year-old woman using the technique of elevation and particularly the insetting of the flap. This pedicled flap was robust and reliable, producing a labium that was natural in appearance with good-quality skin cover and a protective sensation. The patient was satisfied with both the cosmetic appearance and normal sensation of the reconstructed labia. Additionally, the linear scar at the donor site was located along the inguinal fold, and the flap was accepted by the patient as an ideal tissue for reconstruction of the large labial defect.