Modified Lotus Petal Flap for Vulvo-Vaginal Reconstruction after Resection for Vulvar Cancer − A Single Institution Experience

Abstract

Introduction:

Tumour of the vulva is an uncommon pathology that requires radical surgery with wide tumour excision associated with lymphadenectomy. The reconstruction after demolitive surgery is necessary, and the need of new flaps has led us to evaluate the feasibility and efficacy of the previously described lotus petal flap, a local subcutaneous pedicle rotation flap. However, the lotus petal flap has not yet come into wide use, moreover, in the literature there are still only few papers on this topic.

Patients, Materials and Methods:

From July 2007 to October 2010 we performed 69 modified lotus petal flaps in 41 patients at San Gerardo Hospital, Monza. 28 were bilateral flaps and 13 singular flaps.

Results:

We report very few complications: 1 case of partial skin flap necrosis, 1 case of total flap necrosis and 2 cases of donor site wound breakdown. Mean age was 72 years (range: 53−87 years) and mean surgery time was 1 h 25 min (range: 45 min–2 h 45 min). The mean length of follow-up was 15 months (range: 4–42 months). Functional and ­aesthetic results were considered optimal.

Conclusions:

We believe that this flap represents an optimal solution to perineal reconstruction after radical vulvectomy because it has a low rate of complications, it is safe, easy and fast to perform and it has a good functional and ­aesthetic result.

Zusammenfassung

Einleitung:

Tumoren der Vulva sind selten und bedürfen der radikalen Chirurgie mit ausgedehnter Tumorexzision sowie begleitender Lymphadenektomie. Nach radikaler Operation ist die Rekonstruktion notwendig. Die Erfordernis neuer Lappenplastiken veranlasste uns zur Evaluation der Machbarkeit und Effektivität des sogenannten Lotusblatt Lappens, eines lokalen subkutanen gestielten Rotationslappens. Die Lotusblattplastik hat bisher keine weite Verbreitung gefunden und Publikationen hierzu sind rar.

Patienten, Material und Methoden:

Von Juli 2007 bis Oktober 2010 wurden 69 modifizierte Lotusblatt Lappenplastiken an 41 Patienten am San Gerardo Krankenhaus in Monza durchgeführt. Hiervon waren 28 bilaterale Lappenplastik und 13 unilaterale Lappenplastiken.

Ergebnisse:

Insgesamt traten wenig Komplikationen auf: ein Fall einer partiellen Lappennekrose, ein Fall einer totalen Lappennekrose und 2 Wundheilungsstörungen im Bereich des Hebedefekts. Das mittlere Alter lag bei 72 (53–87) Jahren und die mittlere Operationsdauer war 1 h 25 min (45 min-2 h 45 min). Die mittlere Follow-up Dauer lag bei 15 (4–42) Monaten. Funktionale und ästhetische Ergebnisse wurden als optimal beurteilt.

Schlussfolgerung:

Unserer Meinung nach stellt diese Lappenplastik zur perinealen Rekonstruktion nach radikaler Vulvektomie eine ideale Lösung dar, da die Komplikationsrate gering ist und die Durchführung einfach, schnell uns sicher gelingt und das funktionale und ästhetische Ergebnis gut sind.

Key words

lotus petal flap - vulvar reconstruction - perineal reconstruction - subcutaneous pedicle - vulvar cancer

Schlüsselwörter

Lotusblatt Lappenplastik - Vulvarekonstruktion - perineale Rekonstruktion - subkutaner Stiel - Vulvakarzinom

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