Refinements in the lotus petal flap repair of the vulvo-perineum

Background: Many reconstructive techniques have been used to repair the vulval, vaginal and perianal areas after excision. These range from grafts to various types of flap repair. The authors have modified a procedure called the lotus petal flap repair to provide a simpler, equally reliable, yet aesthetically enhanced technique for vulvo-perineal reconstruction. Methods: Where primary closure was not possible the modified lotus petal flap was employed. The present flap design was based on the dense perforators supplying the perineum. The flap resembles the petals of a lotus flower as in the design of Yii and Niranjan. However, the present modification uses a thinned cutaneous flap without identification of the blood supply. The flap is sited over an area of dense perforators. Transpostion with this thinner design allows for easy coverage of the defects. Results: In the present series of eight patients and 12 flaps no cases of partial or complete flap failure were recorded. The only complications encountered in the series were one case of cellulitis after discharge from hospital, and a single case of urethral incontinence. Conclusions: The modified lotus flap repair is a reliable, simple, and aesthetically appealing alternative to those already available to the plastic surgeon for vulval repair.