Local and distant skin flaps in the reconstruction of vulvar deformities

OBJECTIVES: The purpose of this study was to evaluate the safety and efficacy of skin flaps in vulvar reconstructive surgery. STUDY DESIGN: A retrospective review was performed on 207 consecutive flaps on 191 assessable women referred between 1992 and 1996. Outcome measures were wound closure, healing, restoration of coital function, and final result after any secondary revision. RESULTS: Primary closure without tension was possible in all but one instance, and 186 (89.9%) wounds healed by primary intention. Of 146 contractures, 95.8% were reparable by simple sliding flaps (YV advancement or "maple leaf"). Conversely, all the 99 tissue deficits required a pivoting design (random transposition, Martius, pudendal thigh, and gracilis or gluteus myocutaneous flaps). Primary success rates decreased sharply with worsening deformity, underlying disease, and complexity of flap design. There were 65 complications among 42 individuals, and 21 women required subsequent Z plasty or a second flap. Nonetheless, disease was cured and function restored in 178 (93.2%) patients. CONCLUSIONS: Sliding or pivoting vulvar flaps are generally reliable. Complex flaps are more difficult, but there are seldom any simpler surgical options.