SKIN FLAP RECONSTRUCTION OF THE PERINEAL DEFECT AFTER RADICAL VULVAR SURGERY

Repair of the perineal defect represents a major problem in patients u ndergoing radical vulvar surgery. From September 1986 to December 1990 , 72 consecutive patients with primary untreated vulvar neoplasia unde rwent radical vulvar surgery with skin flap reconstruction of the peri neal defect. Sixty-three patients had bilateral rhomboid flaps, and 9 had unilateral flap. In 33 cases, because of the wide anterior surgica l defect, an LLL flap of Dufourmentel also was used to cover the mons pubis area. In 19 patients (26%), wound dehiscence was observed in the reconstructed area, with a maximum extension of 70% of the entire wou nd length (mean extension 30%). However, in all but 2 cases, satisfact ory healing occurred without further surgery. Two patients experienced introital stenosis. Of the 33 sexually active patients, 30 (90%) repo rted sexual intercourse to be satisfactory after surgery, with no sign ificant disruption in sexual activity during the follow-up period. No patient experienced fecal incontinence. Two patients complained of uri nary incontinence, and 1 patient had misdirection of the stream postop eratively. The reconstruction of the perineal area resulted in all cas es in a good anatomic effect, with the recreation of a soft perineal b ody. Flap reconstruction after radical vulvar surgery reduces postoper ative morbidity and allows good anatomic and functional results.