Plastic Reconstructive Procedures for Vulvovaginal Defects: Indications, Techniques and Results

Purpose: The rising incidence of vulvar cancer in the last decades has led to an increasing number of plastic reconstructions for vulvar/vaginal defects. Material and Methods: Between 2004 and 2009, 20 women with primary or recurrent vulvar/vaginal cancer, extensive VIN/AIN, large defects after wound infections or vaginal stenosis were treated with 25 vulvar flaps. We used 9 distant flaps (6 VRAM, two M.gracilis and one M.tensor fasciae latae flap) and 15 regional flaps (8 gluteal fold, 4 fasciocutaneous and 3 Singapore flaps). The major indication to use a distant flap was closure of large defects in recurrent vulvar cancer; locoregional flaps were used to cover smaller defects or to preserve vita sexualis in Young women with posterior vulvar tumors. Results: The preparation and insertion of a distant VRAM flap was a reliable procedure to close large defects in the mons pubic area and large defects in the vulvar area; the gluteal fold flap was used to reconstruct the vulva laterally and dorsally; vaginal and periurethral defects were reconstructed ideally with Singapore flaps. Myocutaneous advancement flaps can be used to reconstruct the posterior fourchette to prevent vaginal stenosis. Individualized planning of the reconstructive procedure is key. Severe complications were rare in our series. Conclusion: We conclude that individualized plastic reconstructive procedures are a safe treatment option, when performed by experienced surgical gynecologists who are familiar with plastic reconstructive techniques, to preserve sexual function or close large vulvar defects after resection for recurrent vulvar carcinoma.