Introduction/Background The majority of flaps used in reconstruction of the vulva are local flaps with a random blood supply and consist of the skin and subcutaneous tissue. They include the V-Y advancement flap, the transposition flap and the rhomboid flap. The lotus flap is a transpositional flap with the blood supply from the perineal branches of the internal pudendal artery. It has an axial blood supply at the base and a random blood supply at the tip. It can be 4 times longer than its width and can be rotated more than 90 degrees. The type of flap chosen is based on the size and location of the defect. The V-Y is best for lateral defects, the rhomboid is best for perineal defects and the lotus can be used for anterior lateral or posterior defects.
Methodology The video will show the defect in the vulva and lower vagina that needs to be covered. It will show the harvesting of the flap, rotating it under the vulva tunnel, preparing the recipient graft site and sewing the graft into place.
Results The patient healed primarily. She received 4400 cGy of radiation postop. She did not have stricture or skin breakdown. Photos of the result are shown. She is alive without disease at 2 years.
Conclusion The lotus flap is an excellent flap for reconstruction of the vulva or the lower and mid vagina.
Disclosure Nothing to disclose
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