A New Flap for 3-Dimensional Vulvar and Vaginal Reconstruction: The "Butterfly Flap"

삼차원적 외음부 재건을 위한 나비형피판술

  • Kim, Sang-Wha (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Seo, Byung-Chul (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Oh, Deuk-Young (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Seo, Je-Won (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Sang-Tae (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea) ;
  • Rhie, Jong-Won (Department of Plastic Surgery, College of Medicine, The Catholic University of Korea)
  • 김상화 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 서병철 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 오득영 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 서제원 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 안상태 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 이종원 (가톨릭대학교 의과대학 성형외과학교실)
  • Received : 2010.03.03
  • Accepted : 2010.04.16
  • Published : 2010.11.10

Abstract

Purpose: Traditional radical surgery for vulvar cancer produces severe skin and soft tissue defects in the vulvar and vaginal area. Vulvoperineal V-Y advancement fasciocutaneous flaps have limitations in advancement and tension at the wound margin and vaginal orifice area, causing wound disruption or vaginal wall exposure. Therefore, we designed the "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap for 3-dimensional reconstruction of vagina and vulvar area. Methods: A 27 year-old female was diagnosed with vulvar intraepithelial neoplasia. Radical vulvectomy and full-thickness-skin-graft was performed. We designed a vulvoperineal V-Y advancement fasciocutaneous flap as the greater wing and inguinal rotational skin as the lesser wing. After flap elevation, the inguinal flap was rotated $180^{\circ}$ to reconstruct the labia major and vaginal orifice. The perineum was reconstructed using V-Y advancement flaps. Results: The flap survived completely, without any complications. After 6 months, the patient was able to perform normal sexual activities and after 18 months, the patient was able to give birth to normal child by caesarean section. Conclusion: The traditional vulvoperineal V-Y advancement fasciocutaneous flap is thin, reliable, easily elevated and matches local skin quality. However, the vaginal wall becomes exposed due to limited advancement and tension of the flap. The "Butterfly flap" using a vulvoperineal V-Y advancement fasciocutaneous flap and an inguinal rotational skin flap is useful for the release of vaginal orifice contracture, reconstruction of the labia major, and 3-dimensional reconstruction of vagina and vulvar area.

Keywords

References

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