title: Subunit principle of vulvar reconstruction: algorithm and outcomes.
abstract: BACKGROUND
  Vulvar defects result chiefly from oncologic resection of vulvar tumors. Reconstruction of vulvar defects restores form and function for the purpose of coitus, micturition, and defecation. Many surgical options exist for vulvar reconstruction. The purpose of this article is to present our experience with vulvar reconstruction.
  
  
  METHODS
  From 2007 to 2013, 43 women presented to us with vulvar defects for reconstruction. Their mean age at the time of reconstruction was 61.1 years. The most common cause of vulvar defect was from resection of vulvar carcinoma and extramammary Paget's disease of the vulva. Method s of reconstruction ranged from primary closure to skin grafting to the use of pedicled flaps.
  
  
  RESULTS
  The main complications were that of long term hypertrophic and/or unaesthetic scarring of the donor site in 4 patients. Twenty-two patients (51%) were able to resume sexual intercourse. There were no complications of flap loss, wound dehiscence, and urethral stenosis.
  
  
  CONCLUSIONS
  We present a subunit algorithmic approach to vulvar reconstruction based on defect location within the vulva, dimension of the defect, and patient age and comorbidity. The gracilis and gluteal fold flaps are particularly versatile and aesthetically suited for reconstruction of a variety of vulvar defects. From an aesthetic viewpoint the gluteal fold flap was superior because of the well-concealed donor scar. We advocate the routine use of these 2 flaps for vulvar reconstruction.
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors: Bien-Keem
authors: BK
authors: Tan
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors: Gavin Chun-Wui
authors: GC
authors: Kang
authors: Thomson Women Cancer Centre, Singapore.
authors: Eng Hseon
authors: EH
authors: Tay
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore.
authors: Yong Chen
authors: YC
authors: Por
keywords: Carcinoma; Surgical flaps; Vulvar