USE OF THE UMBILICUS IN RECONSTRUCTION OF THE VULVA AND VAGINA WITH ARECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP

Flap reconstruction of the vulva and vagina following gynecological ab lative procedures has become an integral part of the management of gyn ecological oncology patients, The benefits of flap reconstruction, inc luding early primary healing, improved cosmesis over skin grafting, an d prolonged secondary wound healing, have been well accepted. Addition ally, the creation of a neovagina or neovulva often restores the sexua l function and positive body image of the patient lost to radical proc edures. The gracilis musculocutaneous flap has been used extensively i n flap reconstruction but reports of partial flap necrosis and the nee d for extensive dissection of both thighs have led to alternative flap choices. The rectus musculocutaneous flap, with its hardier cutaneous blood supply, is often too bulky and difficult to inset delicately ar ound the preserved urethral and vaginal cuff. The umbilicus has the re quired soft tissue, and its conically contoured depression allows for delicate insetting of the rectus abdominis musculocutaneous flap aroun d the urethral cuff. We present 2 patients who underwent vertical rect us musculocutaneous flaps with umbilical soft tissue to restore urinar y function and to create a cosmetic nonfunctional vagina.