Modified gluteal-fold flap for the reconstruction of vulvovaginal defects

Background Reconstruction of vulvovaginal defects after tumor excision requires good-quality skin cover because of the cosmetic and functional importance of this region. Although numerous techniques for vulvovaginal reconstruction have been described, an ideal approach has yet to be widely accepted. Methods Seven gluteal-fold flaps advanced in a V-Y fashion were used to cover vulvovaginal defects in five patients who underwent surgical treatment for extramammary Paget's disease or carcinoma of the vulva. Results Each flap survived completely with no complication other than partial dehiscence in one case and temporary postoperative discomfort and pain upon sitting. None of the patients suffered from recurrence of the tumor. Conclusions In our experience, this flap is easily elevated, not bulky, and reliable because it is supplied by the internal pudendal artery and vein perforators without excessive skeletonization of the vascular pedicle, and it has matched local skin quality. In addition, it has minimal donor-site morbidity as the scar is concealed in the gluteal fold. It can cover medium-sized vulvovaginal defects after tumor excision.