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505 Keystone flap application in vulvo-perineal reconstructive surgery: quality of life and long term follow up
  1. Giuseppina Fais1,2,
  2. Alfonso Altieri1,
  3. Caterina Chilà1,
  4. Andrea Ungredda1,
  5. Filippo Boriani3,
  6. Enrica Bentivegna2,
  7. Valerio Mais1,
  8. Stefano Angioni1 and
  9. Michele Peiretti1
  1. 1Division of Gynecology and Obstetrics (AOU di Cagliari), Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
  2. 2AP-HP, Centre Université Paris Cité, Hôpital européen Georges Pompidou, Service de Chirurgie Cancérologique Gynécologique et du Sein, Paris, France
  3. 3Department of Plastic Surgery and Microsurgery, Teaching Hospital of Monserrato, Cagliari, Italy


Introduction/Background Various local flaps have been described for vulvar reconstructive surgery. This study aimed to evaluate the long-term follow up (FU), results and satisfaction of those patients who underwent Keystone perforator island flaps (KPIF) technique after radical vulvectomy.

Methodology We analyzed demographics, complications, pathologic results, clinical and oncological outcomes of all patients undergone KPIF for vulvar cancer in our institution. The benefits, cosmetic results and satisfaction in term of patients’ quality of life were collected at discharge, after one month and during FU. The long-term FU was collected using oral interview and gynecological examination.

Results From 2016 to 2023, we selected eleven patients (mean age 73 years) that underwent vulvectomy: nine for squamous cells vulvar cancer and two for Paget disease. The defects were successfully covered by the KPIF technique in all patients. Nine patients had a quick recovery and were discharged in postoperative day 5. Two patients were discharged after 20 days due to wound infections. Two patients were readmitted respectively on postoperative day 14 and day 21 due to flap dehiscence and surgical revision was required.

One month after surgery all the wounds were completely healed and there were no differences in colour compared to the surrounding skin. Six months after surgery, all patients were satisfied, no one developed problems due to scarring even at the donor site and no discomfort in sitting or walking or urinary tract problem had experienced. After a mean time FU of 36 months two recurrences occurred within the first year after surgery, respectively vaginal and cutaneous. Both patients died for the progression of disease.

Conclusion KPIF seems to be associated with low complication rates, rapid recovery and good cosmetic outcomes. This technique is well tolerated by patients over time with high satisfaction rates. Therefore, further studies with validated questionaries and larger sample size are needed.

Disclosures None

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