PDF herunterladen
Open Access
CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2606-9515
Case Report

Overcoming the Three-Dimensional Complexity of Vulvar Defects: A Stepwise, Multi-Flap Approach

Autoren

  • Chuan-Han Ang 

    1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore

  • Walter J.X. Tan 

    2   Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

  • Bien-Keem Tan 

    1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore

  • Khong-Yik Chew 

    1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore

Funding This work was supported in part by the ST Lee and HL Lee Distinguished Professorship in Plastic Surgery and Regenerative Medicine, Duke-NUS Medical School, Singapore.
Weitere Informationen
  Lizenzen und Reprints

Abstract

Complex vulvar defects are challenging owing to their three-dimensional characteristics. We introduce a combined flap approach to maximize the use of locoregional tissues. Four patients had defects involving the vaginal wall, anal canal, and perineum, with a size range of 108 to 157 cm2. The outcomes were analyzed using a questionnaire regarding micturition, defecation, coital function, introitus opening, and aesthetics. For the vulva, the gluteal fold flap was the primary flap, which was augmented by the mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap. The perianal skin and anal defects were covered by the gluteal fold and buttock VY advancement flaps. Patients' satisfaction scores were favorable on follow-up. Our multi-flap approach optimized the aesthetic and functional results of combined vulvar–anal defects.

Keywords

extramammary Paget's disease - squamous cell carcinoma - vulvar reconstruction

Authors' Contributions

C-H.A. and B-K.T. contributed to the study design. W.J.X.T. and C-H.A. contributed to the methodology, validation, and manuscript writing. Final review and editing were performed by C-H.A., B-K.T., and K-Y.C.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was performed with and approved by the SingHealth Centralised Institutional Review Board with approval reference code 2024/2283. For this type of retrospective study, decision for publication did not affect management of the patient.


Patient Consent

Informed consent was obtained from the patients for publication of this article and accompanying images.


Supplementary Material



Publikationsverlauf

Eingereicht: 02. März 2024

Angenommen: 03. Mai 2025

Accepted Manuscript online:
13. Mai 2025

Artikel online veröffentlicht:
11. Juli 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA