Total Vaginal Reconstruction with Bilateral Obturator Fasciocutaneous Flaps

Abstract

INTRODUCTION: Total vaginal reconstruction remains a surgical challenge requiring a reliable, well-vascularized, sensate, flexible tube of adequate dimensions that resists contracture. We developed the obturator fasciocutaneous flaps to accomplish these goals. METHODS: Eleven patients underwent complete vaginal reconstruction with bilateral obturator flaps. A proximal medial thigh paddle was incised beginning at the anterior apex of the flap over the adductor longus muscle. The flap was mobilized on its septocutaneous pedicle between the gracilis and adductor longus muscles which carries cutaneous branches of the obturator artery and nerve (Figure). The anterior fascia of the gracilis muscle was included in the flap pedicle. The flap was transferred into the vaginal defect through a subcutaneous and subfascial dissected tunnel between the vaginal defect and the base of the obturator flap. Bilateral flaps were coapted to form a neovagina.RESULTS: The following 2 patients illustrate the procedure. Patient A is a 26-year-old woman presenting with congenital absence of the vagina. Two weeks before obturator flap transfer bilateral flaps were thinned and allowed to heal in place. Patient A experienced no postoperative complications and became sexually active 8 weeks after reconstruction without pain. Patient B is a 40-year-old woman presenting with squamous dysplasia of the vagina. She was treated with a vaginectomy and immediate reconstruction with bilateral obturator flaps. Patient B experienced no postoperative complications and regained painless sexual function. CONCLUSION: Bilateral obturator flaps for total vaginal reconstruction are a reliable reconstruction technique for a variety of indications and provide functionally and cosmetically acceptable repair.