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Vulvar Reconstruction Following Surgery for Vulvar Cancer Using a Stepladder V-Y Advancement Medial Thigh Flap
  1. Hidetaka Nomura, MD, PhD*,
  2. Takuma Maeda, MD,
  3. Tomoka Usami, MD*,
  4. Akiko Abe, MD*,
  5. Akiko Yamamoto, MD*,
  6. Maki Matoda, MD*,
  7. Sanshiro Okamoto, MD*,
  8. Eiji Kondo, MD*,
  9. Kohei Omatsu, MD*,
  10. Kazuyoshi Kato, MD*,
  11. Kenji Umayahara, MD*,
  12. Kuniko Utsugi, MD*,
  13. Nobuhiro Takeshima, MD* and
  14. Masayuki Sawaizumi, MD
  1. *Departments of Gynecology and
  2. Departments of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan.
  1. Address correspondence and reprint requests to Hidetaka Nomura, MD, PhD, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, Japan 135-8550. E-mail:


Objective The aim of this study was to identify the risks and benefits of the stepladder V-Y advancement medial thigh flap for vulvovaginal reconstruction in comparison to direct skin closure.

Methods Fifty-four patients with vulvar cancer treated in our hospital between 1992 and 2013 were enrolled in this study. The cohort group (group A) consisted of 25 patients who underwent surgery from August 2006 until April 2013. During this period, we changed our surgical paradigm to incorporate reconstructive plastic surgery immediately following surgery for vulvar cancer performed by gynecologic oncologists. The control group (group B) consisted of 29 patients treated between 1992 and August 2006. During this period, our surgical approach was limited to direct skin closure with no reconstructive plastic surgery. Perioperative findings and clinical outcomes were compared retrospectively.

Results Patient characteristics and surgical procedures, other than the reconstructive surgery, were the same for the 2 groups. The mean blood loss and operative times were similar, and there were no major complications in either group; however, the average length of hospital stay was significantly shorter in group A (P = 0.04).

Conclusions Stepladder V-Y advancement medial thigh flap lowers posttreatment morbidity and improves quality of life for patients with vulvar cancer. Rapid recovery from surgery is reflected in the short hospital stay, and it enables immediate induction of adjuvant therapy. It may possibly contribute to improved treatment outcome.

  • Hospital stay
  • Reconstruction
  • V-Y advancement flap
  • Vulvar cancer

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  • This study has no sources of support.

  • The authors declare no conflicts of interest.