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Abstract
Introduction/Background In recent years, there has been an increase in the incidence of precursor vulvar pathology and vulvar carcinoma in younger women. This is associated with persistent infections caused by the HPV virus. This, together with the classically presented vulvar carcinomas (elderly women, focal lesions on an area of atrophy), have led to seeking surgical treatments with less consequences and sexual and psychological repercussions, since in some cases the extent of excision is extensive, reaching the vulvectomy.
Methodology Faciocutaneous flaps
Are defined by the presence of the aponeurotic or fascial plane in their composition, in addition to the segment of skin and overlying subcutaneous tissue. The fasciocutaneous vascular system is made up of the different dermal, subdermal and fascial plexuses, being interrelated (2).
48-year-old patient, diagnosed with vulvar Paget's disease, with multiple excisions and recurrences (4). Wide local re-excision is designed, with a Y-V flap for closure. The final result is presented after 3 months.
Results Fasciocutaneous flaps
Are flaps composed of skin, subcutaneous tissue, and the underlying fascia. They are commonly based on vessels that arise in fascial planes between muscles and do not intrinsically include any muscle in their pattern.
The Y-V flap for the treatment of vulvar defects due to oncological surgery, the flap is designed before surgery with a triangular pattern, the base being the vulvar defect and the apex along the gluteal fold and below the ischial tuberosity.
The flap elevation is performed from medial to distal in a plane above or below the deep fascia, depending on the degree of advancement required. The sensitivity of the flap is ensured by the inclusion of the surface branches of the posterior femoral cutaneous nerve, which must be identified and preserved in the gluteal fold, and the terminal branches of the pudendal nerve. The flap is placed and sutured to the mucocutaneous junction.
Conclusion The Y-V flap is well used in all cases and we also combine it with anothers.
Disclosures these technicsare mandatory to be use in centers of reference.