Vulvar reconstruction by perforator flaps: Algorithm for Flap Choice Based on the Topography of the Defect.

OBJECTIVE Many techniques have been proposed to reconstruct acquired vulvar defects. In our experience every type of vulvar defect can be repaired with two pedicled flaps: the pedicle Deep Inferior Epigastric Perforator flap and the Lotus Petal Flap. MATERIALS AND METHODS We report our reconstructive algorithm for vulvar reconstruction, based on the topography of the defect, applied in 22 consecutive patients from 2000 to 2012. According to the proposed algorithm, Deep Inferior Epigastric Perforator flap and Lotus Petal Flap (mono or bilateral type) can repair all kinds of wide vulvar defects. Surgical defects were classified in type I (IA and IB) and type II in relation to the anatomy of the defect. RESULTS No major complications were reported in our series. All patients reported satisfactory results, both functionally and aesthetically. CONCLUSION We propose an easy classification of acquired vulvar defects separating the ones consequent only to the vulvar resection, with preservation of vagina (type I), by the wider defects following vaginal and vulvar resection (type II); type I can be subclassified into defects consequent to half-vulvar resection (type IA) or to total vulvar resection (type IB). Type I defects (IA and IB) can be reconstructed with mono or bilateral Lotus Petal Flap; in type II resections we have a great wound that required more tissue to fulfill the pelvic dead space, so we prefer pedicle Deep Inferior Epigastric Perforator flap.