PUDENDAL THIGH FASCIOCUTANEOUS FLAPS FOR VAGINAL RECONSTRUCTION IN GYNECOLOGIC ONCOLOGY

The pudendal thigh is a sensate fasciocutaneous flap supplied by the p osterior labial artery. We report on the results of pudendal thigh fla ps used for vaginal reconstruction in eight patients at the time of pe lvic exenteration (6) and radical vaginectomy (2). Patients were inter viewed and results were assessed 5 to 19 months after surgery. The fla ps were raised in the thigh creases just lateral to the hair bearing a rea of the labia majora and included skin, subcutaneous tissues, deep fascia,of the thigh, and the epimysium of the adductor muscles. Flap s izes varied from 9 x 4 cm to 15 x 6 cm. Bilateral flaps were used in s even patients. The flaps were technically easy to perform. Partial (ap ical) flap necrosis occurred in four patients. One patient developed c omplete necrosis of bilateral flaps, followed by an enterovaginal fist ula. One patient whose flaps did not necrose developed a rectovaginal fistula at the site of rectal reanastomosis. The functional results ar e disappointing. The only patient having successful vaginal intercours e had a unilateral flap reconstruction following lower vaginectomy in a nonirradiated pelvis. No patient with bilateral flaps or prior pelvi c irradiation has had successful coitus. Other long-term sequelae incl ude vulvar pain (2), chronic vaginal discharge (2), hair growth (4), a nd protrusion of the flaps (2). These vulvovaginal symptoms discourage patients and their partners from genital contact. Breaching the integ rity of the vulva to construct a neovagina that is likely to be unsuit able for sexual intercourse may deprive women of their,only potential for normal genital sexual responsiveness. Techniques of vaginoplasty r equire continued assessment. (C) 1994 Academic Press, Inc.