Defects involving specialised areas with characteristic anatomical features, such
as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures.
The vulva, a complex 3-dimensional structure, can also be reconstructed through a
sharing procedure drawing upon the contralateral vulva. In this report, we present
the interesting case of a patient with chronic, massive, localised lymphedema of her
left labia majora that was resected in 2011. Five years later, she presented with
squamous cell carcinoma over the left vulva region, which is rarely associated with
chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy
defect with a labia majora sharing procedure is novel and has not been previously
described. The labia major flap presented in this report is a shared flap; that is,
a transposition flap based on the dorsal clitoral artery, which has consistent vascular
anatomy, making this flap durable and reliable. This procedure epitomises the principle
of replacing like with like, does not interfere with leg movement or patient positioning,
has minimal donor site morbidity, and preserves other locoregional flap options for
future reconstruction. One limitation is the need for a lax contralateral vulva. This
labia majora sharing procedure is a viable option in carefully selected patients.
Keywords
Perineum - Lymphedema - Carcinoma, squamous cell
