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Introduction: Surgical treatment is the gold standard of care for vulvar cancer and is burdened by a high risk of wound complications due to the poor healing typical of the female genital area. Moreover, this malignancy has a high risk of local relapse even after wide excision. For these reasons, secondary reconstruction of the vulvoperineal area is a relevant and challenging scenario for gynecologists and plastic surgeons. The presence of tissue already operated on and undermined, scars, incisions, the possibility of previous radiation therapy, contamination of urinary and fecal pathogens in the dehiscent wound or ulcerated tumor, and the unavailability of some flaps employed during the primary procedure are typical complexities of this surgery. Due to the rarity of this tumor, a rational approach to secondary reconstruction has never been proposed in the literature. Methods: In this observational retrospective study, we reviewed the clinical data of patients affected by vulvar cancer who underwent secondary reconstruction of the vulvoperineal area in our hospital between 2013 and 2023. Oncological, reconstructive, demographic, and complication data were recorded. The primary outcome measure was the incidence of wound complications. The secondary outcome measure was the indication of the different flaps, according to the defect, to establish an algorithm for decision-making. Results: Sixty-six patients were included; mean age was 71.3 ± 9.4 years, and the mean BMI was 25.1 ± 4.9. The mean size of the defect repaired by secondary vulvar reconstruction was 178 cm2 ± 163 cm2. Vertical rectus abdominis myocutaneous (VRAM), anterolateral thigh (ALT), fasciocutaneous V-Y (VY), and deep inferior epigastric perforator (DIEP) were the flaps more frequently employed. We observed five cases of wound breakdown, one case of marginal necrosis of an ALT flap, and three cases of wound infection. The algorithm we developed considered the geometry and size of the defect and the flaps still available after previous surgery. Discussion: A systematic approach to secondary vulvar reconstruction can provide good surgical results with a low rate of complications. The geometry of the defect and the use of both traditional and perforator flaps should guide the choice of the reconstructive technique. [ABSTRACT FROM AUTHOR]

IntroductionSurgical treatment is the gold standard of care for vulvar cancer and is burdened by a high risk of wound complications due to the poor healing typical of the female genital area. Moreover, this malignancy has a high risk of local relapse even after wide excision. For these reasons, secondary reconstruction of the vulvoperineal area is a relevant and challenging scenario for gynecologists and plastic surgeons. The presence of tissue already operated on and undermined, scars, incisions, the possibility of previous radiation therapy, contamination of urinary and fecal pathogens in the dehiscent wound or ulcerated tumor, and the unavailability of some flaps employed during the primary procedure are typical complexities of this surgery. Due to the rarity of this tumor, a rational approach to secondary reconstruction has never been proposed in the literature.MethodsIn this observational retrospective study, we reviewed the clinical data of patients affected by vulvar cancer who underwent secondary reconstruction of the vulvoperineal area in our hospital between 2013 and 2023. Oncological, reconstructive, demographic, and complication data were recorded. The primary outcome measure was the incidence of wound complications. The secondary outcome measure was the indication of the different flaps, according to the defect, to establish an algorithm for decision-making.ResultsSixty-six patients were included; mean age was 71.3 ± 9.4 years, and the mean BMI was 25.1 ± 4.9. The mean size of the defect repaired by secondary vulvar reconstruction was 178 cm2 ± 163 cm2. Vertical rectus abdominis myocutaneous (VRAM), anterolateral thigh (ALT), fasciocutaneous V-Y (VY), and deep inferior epigastric perforator (DIEP) were the flaps more frequently employed. We observed five cases of wound breakdown, one case of marginal necrosis of an ALT flap, and three cases of wound infection. The algorithm we developed considered the geometry and size of the defect and the flaps still available after previous surgery.DiscussionA systematic approach to secondary vulvar reconstruction can provide good surgical results with a low rate of complications. The geometry of the defect and the use of both traditional and perforator flaps should guide the choice of the reconstructive technique.

Surgical therapy for vulvar cancer involves wide defects that often require flap-based reconstruction. The goal of the reconstruction is fast wound healing with low donor site morbidity. This is a retrospective observational cohort study in which we reviewed all patients who underwent surgery for vulvar cancer followed by reconstruction using the Superficial Circumflex Iliac Artery Perforator (SCIP) flap between 2015 and 2020. The primary outcome measure of this investigation was the incidence of wound complications. The secondary outcomes were the surgical indications in terms of establishing the anatomical subunits involved in the resection that made us choose this flap for reconstruction. This study adheres to the STROBE guidelines. Thirty-two patients were included; in two cases, the flap was performed bilaterally for a total of 34 SCIP flaps. The mean age of patients was 70.6 ± 8.6 years, and the mean BMI was 26.8 ± 4.7. The SCIP flap was always feasible. The mean flap size was 128.8 ± 74.3cm2. Three patients showed wound complications. In every patient, the defect involved the vulva, perineum and inguinal area; in 18 patients, the mons pubis was also involved. The mean follow-up was 30 months. During the follow-up, six patients died, and four showed local or nodal cancer relapse. Our results suggest that the advantages of SCIP flap for the reconstruction of vulvoperineal defects secondary to vulvar cancer surgery include low complication rate, minimal donor site morbidity, quick dissection, proximity of donor and recipient sites, possibility to harvest large skin islands of variable thickness and chimeric flaps. [ABSTRACT FROM AUTHOR]

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date. [ABSTRACT FROM AUTHOR]

Inguinal block dissection is a necessary component in the treatment of certain cancers. Cancer of the penis is not an uncommon malignancy in the Indian subcontinent and while no one questions the treatment of the primary lesion, the need to remove the inguinal lymph glands concurrently, remains a matter of great controversy. Never the less, the survival of patients with penile cancer depends solely on the presence or absence of metastasis to the inguinal lymph nodes. The hesitation in offering inguinal lymph node dissection in every case is significantly related to the morbidity of the procedure in an attempt to reduce these complications, skin flaps can be used to cover the groin. This article looks at various flaps that can be used in groin reconstruction.

The rectus abdominis muscle and musculocutaneous flaps have contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous and muscular tissue. In this article, outcomes of soft-tissue defects after reconstruction with the rectus abdominis muscle and musculocutaneous flaps were retrospectively analyzed. From August 2003 to June 2009, 25 flaps were transferred to reconstruct a wide variety of soft-tissue defects in the breast, chest wall, groin, perineal, and head and neck regions, as well as the upper and lower extremities. The rectus abdominis muscle and musculocutaneous flaps were used as part of 11 different approaches in 25 cases. There were 13 male and 12 female patients; the mean patient age was 44.2 years. The mean follow-up period was 8 months (range, 4-15 months). The overall success rate was 100%, and all flaps healed uneventfully. All reconstructive procedures were completed without any major complications. Rectus sheets were repaired primarily, and no mesh application was used. Minor complications related to transferred flaps were wound infection and dehiscence in one case, wound dehiscence in two cases, and flap lymphedema in one case. Minor complications related to the donor site were seroma in one case and wound infection and dehiscence in another case. This study presents our experience with the rectus abdominis muscle and musculocutaneous flaps in a series of 25 cases. The indications for the use of this particular flap with other flaps are discussed. [ABSTRACT FROM AUTHOR]

Summary: Background: Anterolateral thigh flap is a safe and reliable flap for soft tissue reconstruction. It has successfully been used as free flap reconstruction for defects in the head and neck region, the upper extremities and lower extremities. However, there were only a few reports in the literature concerning the clinical application of this flap for regional reconstruction. Methods: The authors describe their experience of using the pedicled island anterolateral thigh flap for reconstruction of soft tissue defects in neighbouring areas. Representative cases are presented for illustration. Result: Between July 2005 and September 2006, seven patients underwent an immediate reconstruction with pedicled anterolateral thigh flap. The patients were between 49 and 69 years old. The size of the flaps measured from 5×8cm to 15×15cm. They were prepared as myocutaneous flaps in three cases and as perforator flaps in four cases. One patient, who had the largest flap harvested, needed skin grafting of the donor site. Primary closure was performed for all other cases. All flaps survived without any vascular compromise and the donor site healed without complication. Conclusion: Our study has shown that the pedicled anterolateral thigh flap is a safe and reliable flap for repair of defects at the internal pelvis, lateral thigh, groin, and genitoperineal region. The long vascular pedicle and having no restriction to the arc of rotation are keys to the successful transposition of the flap for immediate reconstruction of soft tissue defects in neighbouring areas. [Copyright &y& Elsevier]

Inguinal block dissection is a necessary component in the treatment of certain cancers. Cancer of the penis is not an uncommon malignancy in the Indian subcontinent and while no one questions the treatment of the primary lesion, the need to remove the inguinal lymph glands concurrently, remains a matter of great controversy. Never the less, the survival of patients with penile cancer depends solely on the presence or absence of metastasis to the inguinal lymph nodes. The hesitation in offering inguinal lymph node dissection in every case is significantly related to the morbidity of the procedure in an attempt to reduce these complications, skin flaps can be used to cover the groin. This article looks at various flaps that can be used in groin reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Groin defects with exposed complex structures are challenging to treat. Perforator flaps provide a contemporary alternative to established muscle flaps to cover all varieties of groin defects, with minimum donor site morbidity, less postoperative pain, and faster rehabilitation. In this retrospective single-center analysis, we aimed to show that pedicled perforator flaps are a valid option for groin defect reconstruction. We present three different pedicled perforator flaps and discuss the flap selection process and their distinct advantages and disadvantages., Methods: A series of 54 consecutive cases of patients with groin defects were allocated into three different treatment groups. Reconstruction was performed utilizing the anterolateral thigh (ALT) flap, the pedicled posteromedial thigh (PMT) perforator flap, and the vertical deep inferior epigastric artery perforator (vDIEP) flap., Results: All 54 flaps survived. Early complications included one hematoma (vDIEP) and two infections (ALT and PMT). Delayed complications occurred in three recipient-site seromas (ALT, PMT, and vDIEP), one donor-site seroma (vDIEP), and one flap dehiscence (ALT). All flaps provided stable coverage during 3-12 months of follow-up., Conclusion: We propose pedicled perforator flaps to be a safe and reliable option for groin defect reconstruction. The pedicled PMT flap should be the first choice if the profunda femoris artery and its perforators are available. The ALT flap can be applied as a second choice, especially if complex groin defect with exposed vascular prosthesis reconstruction is needed because of its versatile expansion options, for example, as a chimeric flap using a portion of the vastus lateralis muscle. In cases where the profunda femoris artery is not available, the vDIEP flap should be the preferred method., (Copyright © 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)