Skin flap reconstruction of the perineal defect after radical vulvar surgery

Repair of the perineal defect represents a major problem in patients undergoing radical vulvar surgery. From September 1986 to December 1990, 72 consecutive patients with primary untreated vulvar neoplasia underwent radical vulvar surgery with skin flap reconstruction of the perineal defect. Sixty-three patients had bilateral rhomboid flaps, and 9 had unilateral flap. In 33 eases, because of the wide anterior surgical defect, an LLL flap of Dufourmentel also was used to cover the mons pubis area. In 19 patients (26%), wound dehiscence was observed in the reconstructed area, with a maximum extension of 70% of the entire wound length (mean extension 30%). However, in all but 2 cases, satisfactory healing occurred without further surgery. Two patients experienced introital stenosis. Of the 33 sexually active patients, 30 (90%) reported sexual intercourse to be satisfactory after surgery, with no significant disruption in sexual activity during the follow-up period. No patient experienced fecal incontinence. Two patients complained of urinary incontinence, and 1 patient had misdirection of the stream postoperatively. The reconstruction of the perineal area resulted in all cases in a good anatomic effect, with the recreation of a soft perineal body. Flap reconstruction after radical vulvar surgery reduces postoperative morbidity and allows good anatomic and functional results.