title: Vulvar Reconstruction by Perforator Flaps: Algorithm for Flap Choice Based on the Topography of the Defect.
abstract: OBJECTIVE
  Many techniques have been proposed to reconstruct acquired vulvar defects. In our experience, every type of vulvar defect can be repaired with 2 pedicled flaps, namely, the pedicle deep inferior epigastric perforator (DIEP) flap and the lotus petal flap (LPF).
  
  
  METHODS
  We report our reconstructive algorithm for vulvar reconstruction, based on the topography of the defect, applied in 22 consecutive patients from 2000 to 2012. According to the proposed algorithm, DIEP flap and LPF (monolateral or bilateral type) can repair all kinds of wide vulvar defects. Surgical defects were classified as type I (IA and IB) and type II in relation to the anatomy of the defect.
  
  
  RESULTS
  No major complications were reported in our series. All patients reported satisfactory results, both functionally and aesthetically.
  
  
  CONCLUSIONS
  We propose an easy classification of acquired vulvar defects separating the ones consequent only to the vulvar resection, with preservation of vagina (type I), by the wider defects after vaginal and vulvar resection (type II); type I can be subclassified into defects consequent to half-vulvar resection (type IA) or to total vulvar resection (type IB). Type I defects (IA and IB) can be reconstructed with monolateral or bilateral LPF; in type II resections, we have a great wound that required more tissue to fill the pelvic dead space, so we prefer pedicle DIEP flap.
authors.affiliation: *Plastic Surgery Department, and †Oncologic Gynecology Department, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Negosanti
authors.forename: Rossella
authors.initials: R
authors.lastname: Sgarzani
authors.forename: Erich
authors.initials: E
authors.lastname: Fabbri
authors.forename: Stefano
authors.initials: S
authors.lastname: Palo
authors.forename: Carlo Maria
authors.initials: CM
authors.lastname: Oranges
authors.forename: Pierandrea
authors.initials: P
authors.lastname: De Iaco
authors.forename: Guido
authors.initials: G
authors.lastname: Zannetti
authors.forename: Federico
authors.initials: F
authors.lastname: Contedini
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cipriani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D061525:Perforator Flap; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing