Versatile lotus petal flap for vulvoperineal reconstruction after gynecological ablative surgery

The objective of the present work was to assess the efficacy and complications of the use of the lotus petal flap in the vulvoperineal reconstruction among female patients treated for vulvar malignancies. Between December 2000 and April 2003, five patients underwent vulvoperineal reconstructions with the fasciocutaneous skin flaps elevated from gluteal folds immediately after vulvoperineal ablative surgeries at National Cancer Center Hospital, Tokyo, Japan. The mean surface area of vulvoperineal tissue defects was 157.9 cm ² (64.0-195.0 cm ²), which could be filled completely by bilateral lotus petal flaps. The mean length of follow-up was 18 months (7-32 months). All flaps successfully survived without fatal necrosis. In postoperative follow-up, all patients had no complaint of pain and no abnormal sensation at the site of flap or at the donor site, and the lotus petal flap caused no severe damage to excretion, mobility of the hip, or the sensation in the vulvoperineal area. The gluteal fold could make the donor-site scar stand out in all patients. The lotus petal flap is thought to be one of the most ideal reconstructive procedures for vulvoperineal region from various viewpoints of oncology, function, wound healing, and cosmetic surgery.