Treatment of vaginal stenosis with fasciocutaneous Singapore flap.
BACKGROUND
Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap.


METHODS
We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation. She subsequently developed a rectovaginal fistula requiring repair with a right-sided gracilis flap. When her stenosis recurred, she underwent vaginal reconstruction with a medial thigh flap.


RESULTS
The Singapore flap is a pudendal thigh flap centered on the labial crural fold with a base at the perineal body. As the cutaneous innervation is spared, this flap is sensate. This technique is one option for patients with complex vaginal stenosis who have failed conservative management. However, it is imperative the patient perform vaginal dilation postoperatively and maintain close follow-up with her surgeon, as vaginal stenosis can recur.


CONCLUSIONS
Postradiation vaginal stenosis is a complex condition to treat; however, vaginal reconstruction with a thigh flap can provide excellent cosmetic and functional results.
Department of Urology, Cleveland Clinic, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA. marisameyerclifton@gmail.com.
Marisa M
MM
Clifton
Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA.
Raffi
R
Gurunluoglu
Department of Urology, Cleveland Clinic, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA.|Urogynecology, Hospital Dr. Sotero del Rio, Santiago, Chile.|Division de Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Region Metropolitana, Chile.
Javier
J
Pizarro-Berdichevsky
Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA.
Todd
T
Baker
Department of Urology, Cleveland Clinic, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA.
Sandip P
SP
Vasavada
D000328:Adult; D015179:Colorectal Neoplasms / Q000532:radiotherapy; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D011832:Radiation Injuries / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000601:surgery; D012008:Recurrence; D013524:Surgical Flaps; D014621:Vagina / Q000528:radiation effects* / Q000601:surgery
Abnormalities; Dyspareunia; Flap; Pedicled; Radiation-induced; Reconstructive; Surgical procedure; Vaginal diseases
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