Abstract
Vulvar defects following tumor extirpation are most commonly closed primarily by the
gynecologist but larger and/or radiated defects often require reconstruction with
flaps for adequate coverage and wound healing. Recurrence of vulvar carcinomas remains
a challenge, so secondary reconstruction becomes increasingly problematic where locoregional
flaps (i.e., gracilis, rectus, anterolateral thigh, and gluteal flaps) may have already
been utilized, radiated, or have resulted in unacceptable cosmetic or functional morbidity.
We present two cases of recurrent vulvar carcinoma following radiation therapy requiring
total vulvectomy and a novel approach for soft-tissue reconstruction. Previous authors
have reported the use of thinned and split flaps, but we combine these techniques
to split and thin a transversely oriented deep interior epigastric artery perforator (DIEP) flap
to maximize aesthetic results and minimize donor-site morbidity. The DIEP flap is
commonly performed by microsurgeons for autologous free-tissue transfer in breast
reconstruction but also serves as a useful option for large vulvar or perineal defects,
either in primary or secondary reconstruction.
Keywords
vulvar reconstruction - deep inferior epigastric artery perforator flap (DIEP) - vulvectomy
- perineal reconstruction
