Vulvar and vaginal reconstruction using the "angel wing" perforator-based island flap

Abstract

Objective. Vulvar and vaginal reconstruction can be challenging for the reconstructive surgeon. The reconstructive goal is to provide wound healing, adequate function, and acceptable appearance. In the present study, we introduce a new design called the "angel wing" flap, which is a modification of a transposition flap and is based on the perforator concept for vulvar and vaginal reconstruction. Methods. From January 2002 to becember 2013, 23 women underwent reconstruction of vulvar and vaginal defects. Causative factors were vulvar cancer in 14 patients, extramammary Paget's disease in 2, vulvar dysplasia in 5, and combined vulvar and vaginal cancer in 2 patients. Results. A total of 41 flaps were applied. All patients underwent surgical reconstruction in a single step using the "angel wing" flap. Flap size ranged from 4 x 7 to 13 x 6 cm(2) and the operative duration for reconstructive surgery ranged from 30 to 100 min. All the flaps survived with good coverage of the defect. Mean follow-up time after the procedure was 16.1 months (range, 6-30 months). Conclusion. In this article, we introduce a simple and easy reconstructive procedure of the "angel wing" flap. For restoring function, as well as for esthetic purposes, the flap was designed in accordance with the defect since the natural contour of the vulva and vagina is three-dimensional.