Background: The absence of the vulva and vagina is a distressful problem, especially for the sexual life of a woman. The potential benefit associated with the use of various vaginal reconstructive methods was studied.
Methods: Between April 1987, and June 1997, 12 patients undergoing gynecologic carcinoma surgery were treated with simultaneous vulvovaginal reconstruction using local labia majora flaps (1), gracilis myocutaneous flaps (3), and innervated pudendal-thigh flaps (8).
Results: The mean follow-up period was 32 months. There were no major surgical complications, with the exception of one patient who had a ureteroileal fistula after bilateral gracilis myocutaneous flap reconstruction and radiotherapy. One patient received pelvic radiation after bilateral gracilis myocutaneous flap reconstruction, and the complication of perineal bleeding occurred 90 days after the vaginal reconstruction. Another patient had introital stenosis of the neovagina after reconstruction using bilateral labia majora flaps. Seven patients had regular and satisfactory sexual lives. These patients were all treated by innervated pudendal-thigh flap reconstruction.
Conclusion: The innervated pudendal-thigh flap provides a sensitized flap for reconstruction of the vulva and vagina following vulvovaginal carcinoma surgery. For extended carcinoma with vulvovaginal involvement, the gracilis myocutaneous flap is would be better for reconstruction of a large defect.