Objective: To increase the success rate of vaginal reconstruction with pudendal-thigh flap, reduce the chance of hemocirculatory disorder and relieve the deformity of greater lip of pudendum and vaginal orifice.
Methods: From June 1998 to May 2004, 15 patients, 2 males with transsexualism and 13 females with vaginal absence, aged 23-31 years old (26.2 on average), received vaginal reconstruction. Arterial perforator was detected at 3 cm laterally away from the mid-point between the vaginal orifice and the anus. The flap of 12.0 cm x 5.5 cm was designed at the lateral of the greater lip of pudendum, with the groin as the axis. After the flap was elevated beneath the deep fascia, the fascial pedicle was partially severed from lateral to medium, keeping the perforator intact into the flap. Then the flap was transferred through the tunnel to the socket. The inner layer and the orifice were formed.
Results: All flaps survived, and the contour of the vulva was satisfactory. Among the 15 patients, 14 patients' incisions obtained healing by first intention, and only 1 male with transsexualism was discovered to suffer from rectovaginal fistula at the remote juncture of the two flaps at 7 days after the operation. By taking out all the gauze and cleaning the feces, the fistula healed automatically. All patients were followed up for 6 months-3 years. The reconstructed vagina was about 10 cm deep and 2 fingers wide. One female's vagina was found pilous at 20 months after the operation, and no special treatment was given. The other patients' vaginal inner walls were smooth and complete. Two female patients had the experience of sexual intercourse and felt satisfied after using lubricant.
Conclusion: The modified pudendal-thigh flap has reliable blood supply and makes the transferring during vaginal reconstruction more convenient and the contour of the vulva more satisfactory.