title: Profunda artery perforator flap for isolated vulvar defect reconstruction after oncological resection.
abstract: Isolated vulvar reconstruction using profunda artery-based perforator flaps have good functional as well as quality of life restoration. Surgical techniques, complications, and final evaluation using questionnaires are presented.
  
  
  BACKGROUND
  Vulvar reconstruction remains a great challenge to reconstructive surgeons. A local fasciocutaneous flap from the medial thigh is a good option with multiple choices of the donor arteries. Here, we extended the clinical application of a profunda perforator artery (PAP) flap with the design of an island pedicle flap.
  
  
  METHODS
  From 2012 to 2015, 12 female patients with vulvar cancer received tumor ablation and immediate reconstruction using a PAP flap. The flaps (n = 19) were divided into V-Y advancement perforator flap (group I, n = 4) and island pedicle perforator flap (group II, n = 15). All of the demographic data were collected and analyzed.
  
  
  RESULTS
  All of the flaps were transferred successfully, and all of the donor sites were closed without morbidities. Group II was superior to group I because of the smaller required flap size (P = 0.004), the smaller defect size/flap size ratio (P = 0.001), and a lower rate of post-op debridement (P = 0.037). The other parameters were not statistically significant.
  
  
  CONCLUSIONS
  PAP flap is a good choice for vulvar reconstruction. We preferred an island pedicle setting for its thin and pliable fasciocutaneous component and robust flap circulation. The favorable functional and aesthetic results can be achieved with limited donor site morbidities. J. Surg. Oncol. 2016;113:828-834. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Tommy Nai-Jen
authors.initials: TN
authors.lastname: Chang
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Wu
authors.affiliation: Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chun-Shin
authors.initials: CS
authors.lastname: Chang
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, College of Medicine, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D002278:Carcinoma in Situ / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013848:Thigh / Q000098:blood supply / Q000601:surgery; D016896:Treatment Outcome; D014844:Vulva / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000601:surgery*
keywords: PAP flap; deep femoral artery; pedicle perforator flap; profunda artery; vulvar reconstruction