Vulvovaginal Reconstruction Using Pedicle Flaps after Wide Vulvectomy and Total Pelvic Exenteration

26 flaps were used for vulvovaginal reconstruction following radical or wide resection of malignant tumor in 15 patients. There were eleven vulvar carcinoma, two uterus carcinomas, and one vaginal carcinoma. The mean patient age was 65 years (33-85 year-old). 19 gracilis myocutaneous (M-C) flaps were used in ten patients, four posterior thigh fasciocutaneous (F-C) flaps in three patients and three local flaps in two patients. Six gracilis M-C flaps in three patients were used to supplement the dead space and vaginal reconstruction after pelvic exenteration. The other 20 flaps in twelve patients were used for vulvar reconstruction. All but one flap survived. A unilateral gracilis M-C flap in which the skin flap was 25cm in length showed partial necrosis. Two patients receiving gracilis M-C flaps complained of discomfort during gait because of their bulk. One patient receiving posterior thigh F-C flap developed bursitis and required bursectomy. The other patient receiving local flaps needed debridement and closure for wound dehiscence. Gracilis M-C flaps were best suited for reconstructing both the defect after pelvic exenteration and the vagina. Posterior thigh F-C flaps were indicated for large vulvar defect and local flaps were indicated for small defects.