Experience with gluteal V-Y fasciocutaneous advancement flaps in vulvar reconstruction after oncological resection and a modification to the marking: Playing with tension lines.

Many post-vulvectomy vulvar reconstruction solutions, using local fasciocutaneous flaps where possible, have been proposed. We report the use of V-Y advancement flaps from the gluteal fold in medium to large vulvar reconstructions and a simple modification we made to the technique in order to minimise wound-related complications. Between 2006 and 2016, 30 vulvar reconstructions were performed via a total of 59 flaps, 24 of which were raised using the proposed modification to the plasty design. Short- and long-term (24 months) follow-up data were analysed, postoperative flap sensitivity was tested, and any arising complications were recorded. The mean age of patients treated was 75.3 years (51-92 years). The mean monolateral defect dimensions were 7.5 × 4.7 × 2.8 cm. Minor complications were recorded in 23% of patients (14% of flaps). One case of ostial stenosis occurred. Micturition and ambulation recovery was rapid, and flap sensitivity was fully restored 24 months after reconstruction. Scars were well hidden by natural soft tissue folds. The outcomes in this case series confirm that the gluteal V-Y advancement fasciocutaneous flap is a useful and simple technique for reconstructing even large vulvar defects. It has a low functional and aesthetic impact and enables rapid return to autonomy. Moreover, the simple modification to the V-Y flap proposed, designed to reduce tension at the apical part of the wound, appears to reduce the complication rate.

Vulvar reconstruction using a "V-Y" fascio-cutaneous gluteal flap: a valid reconstructive alternative in post-oncological loss of substance.

OBJECTIVE: We will present our experience in vulvar reconstruction using a local fascio-cutaneous flap, in order to get an easier intra-operative management and a good post-operative outcome. METHODS: Between May 2006 and December 2008, eight patients with vulvar carcinomas underwent a vulvar reconstruction, using a V-Y advancement flap of the gluteal fold. This fascio-cutaneous flap, based on the perforator vessels originated from the internal pudendal artery, was used for the reconstructive treatment of patients who had undergone a vulvectomy with medium-size defects. RESULTS: All the 16 flaps prepared survived without major complications. Walking and sitting positions were restored in few post-operative days. Length of hospitalisation was 2-3 weeks. The flaps restored sensitivity few months after surgery. In no case the surgical scars needed being revised. CONCLUSIONS: The follow-up results proved satisfactory in terms of patients' compliance and morphological results. The flap appeared to be thin, well vascularised and very flexible in its advancement. The post-operative follow-up is characterised by a rapid healing and a low incidence of short- and long-term complications.