Labia Majora Share

Abstract

Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.

Bilateral Inferiorly Based Labia Majora Flaps: A Simple Technique for Post Episiotomy Dehiscence Coverage

“…Labia majora flap has been described to reconstruct opposite side labia defects 5 , 25 . The benefits of inferior-based labia majora flap is that it retains the characteristic soft pliable nature and hair-bearing quality of perineal skin, is not bulky, sensory in nature, and has no additional donor site management is required.…”

“…The wound in a perineovulvar region can be closed primarily or with local tissue repositioning if small. Reconstruction with a split-thickness or full-thickness skin graft is not a good option in perineal wound coverage and has a high rate of graft loss, and secondary contracture results in distortion of introitus, with resultant functional and aesthetic sequelae 5 , 6 . Larger defects require local or regional flap from the groin or thigh, furthermore flap viability may be compromised due to mobilization of the legs and stretching of the pedicle 5 , 7 .…”

“…Reconstruction with a split-thickness or full-thickness skin graft is not a good option in perineal wound coverage and has a high rate of graft loss, and secondary contracture results in distortion of introitus, with resultant functional and aesthetic sequelae 5 , 6 . Larger defects require local or regional flap from the groin or thigh, furthermore flap viability may be compromised due to mobilization of the legs and stretching of the pedicle 5 , 7 . Another option that may be tried is inferiorly based labia minora flap but the quality of skin does not match with the recipient site 8 .…”

“…Another option that may be tried is inferiorly based labia minora flap but the quality of skin does not match with the recipient site 8 . The benefits of labia majora flaps are that it has consistent vascular anatomy based on the posterior labial artery, which is a continuation of the internal pudendal artery 5 .…”

A Labia Majora Sharing Perforator Flap for Labial Defect Reconstruction

“…We chose a perforator flap to achieve more mobility of the flap and a less pronounced dog ear. As far as we know, there has been only 1 report on the labial transposition flap, 11 , 12 and our technique is the first one involving a labial sharing flap based on the perforator.…”