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

Abstract

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. 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. 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. 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.