Modified Lotus Petal Flap for Vulvo-Vaginal Reconstruction after Resection for Vulvar Cancer − A Single Institution Experience

Abstract

Introduction: Tumour of the vulva is an uncommon pathology that requires radical surgery with wide tumour excision associated with lymphadenectomy. The reconstruction after demolitive surgery is necessary, and the need of new flaps has led us to evaluate the feasibility and efficacy of the previously described lotus petal flap, a local subcutaneous pedicle rotation flap. However, the lotus petal flap has not yet come into wide use, moreover, in the literature there are still only few papers on this topic. Patients, Materials and Methods: From July 2007 to October 2010 we performed 69 modified lotus petal flaps in 41 patients at San Gerardo Hospital, Monza. 28 were bilateral flaps and 13 singular flaps. Results: We report very few complications: 1 case of partial skin flap necrosis, 1 case of total flap necrosis and 2 cases of donor site wound breakdown. Mean age was 72 years (range: 53?87 years) and mean surgery time was 1?h 25?min (range: 45?min?2?h 45?min). The mean length of follow-up was 15 months (range: 4?42 months). Functional and ?aesthetic results were considered optimal. Conclusions: We believe that this flap represents an optimal solution to perineal reconstruction after radical vulvectomy because it has a low rate of complications, it is safe, easy and fast to perform and it has a good functional and ?aesthetic result.

Better Anatomical and Cosmetic Results Using Tunneled Lotus Petal Flap for Plastic Reconstruction After Demolitive Surgery for Vulvar Malignancy

“…However, because the blood supply of the tissue imported in the form of tunneled lotus flap remains uninterrupted, the risk of such a problem is reduced even in patients who were operated on more than once. The low complication rate in our hands, which is consistent with previous reports, 3,4,6,8,14,15 provides further evidence that the procedure is safe and easy to perform, even in the setting of recurrent disease.…”

“…14 In addition, in this series of 22 tunneled lotus petal flaps, the complication rate was 9%, similar to our previous published data. 6 The tunneled lotus petal flap has been introduced in our practice at the beginning of 2010 and, when applicable the flap lies without tension, has a better anatomic definition, with excellent cosmetic and functional long-term results.…”

Lotus petal flap and vertical rectus abdominis myocutaneous flap in vulvoperineal reconstruction: a systematic review of differences in complications

“…Yii et al [14] were the first in 1996 to report on reconstruction using the LP flap. All but three of these studies are case series [14][15][16][17][18][19][20][21][22][23][24][25][26]. Only Negosanti et al [27], Confalonieri et al [18] and Thiele et al [28] reported a case control study in which a reconstruction with LP flaps was compared with other flaps.…”

“…About half of the studies (56.3%) were small studies (<20 patients), the largest was that of Confalonieri et al which included 106 patients [14,18,[20][21][22]24,[26][27][28]. In 62.5% of the studies, only females were included [14,15,[17][18][19]21,23,[25][26][27]. Mean age of the subjects varied between 50.3 years and 79 years [21,22].…”

Regarding

“…3,4 From 2007, we identified LPF as the most appropriate method of reconstruction after vulvoperineal surgery for both primary and recurrence vulvar malignancy.…”