Pedicle perforator flaps for vulvar reconstruction - New generation of less invasive vulvar reconstruction with favorable results

Objectives. Vulvar reconstruction after cancer surgery remains challenging. Pedicle perforator flaps are believed to be a less invasive option with better cosmesis. Methods. A retrospective reviewidentified 27 flaps in 16 patientswho underwent vulvar reconstruction after cancer surgery using island pedicled perforator flaps. Their average age was 55.7 ± 17.8 years (Range: 22-85). The average BMI was 23.5 ± 4.0 (range: 18.8-28.5). Five of the 16 patients underwent unilateral vulvar reconstruction, and 11 of them underwent bilateral vulvar-perineal reconstructions. The perforator flaps included deep femoral (profunda) artery perforator (DFAP or PAP) flaps (n= 11), medial circumflex femoral perforator (MCFAP) flaps (n = 8), external pudendal artery perforator (EPAP) flaps (n = 2), medial thigh free style perforator flaps (n= 2), and internal pudendal artery perforator flaps (n= 4). Results. All flaps survived with a 100% success rate. Three patients developed small wounds that required debridement and closure after the reconstruction. All donor sites were closed primarily. One patient developed temporary peroneal nerve palsy. During follow-up, none of the patients presented with donor site morbidities. All of the patients were satisfied with the cosmetic and functional results, except that one patient underwent a flap debulking procedure three months after surgery. Conclusions. Compared to traditional myocutaneous flaps, perforator flaps provide thinner fasciocutaneous flaps for vulvar reconstructionwith favorable reconstruction results and fewer donor sitemorbidities. The medial or inner thigh is a region that is rich in perforators, which allow for more versatile flap design according to the defect. Furthermore, most of the donor site can be closed primarily without complications.